TOPLINE:

Initiating biologic therapy as a first-line systemic treatment for moderate-to-severe plaque psoriasis was associated with better skin clearance, low risks for chronic comorbidities, and improved quality of life over 5 years compared with standard stepwise approaches.

METHODOLOGY:

• Researchers conducted a cohort study using the target trial emulation framework, with data of 3702 adult patients with moderate-to-severe plaque psoriasis from the British Association of Dermatologists Biologics and Immunomodulators Register in the UK and the Republic of Ireland collected from September 2007 to December 2024.
• Overall, 3368 patients followed the standard of care (mean age, 42.9 years) and 334 initiated a biologic as their first-line systemic therapy (mean age, 46.2 years).
• The primary outcome was the change in Psoriasis Area and Severity Index (PASI) scores over 5 years, and secondary outcomes included the time to the first achievement of complete skin clearance (a PASI score = 0), change in Dermatology Life Quality Index (DLQI) scores, and time to first newly diagnosed chronic comorbidities.
• Follow-up began at treatment initiation and ended at the earliest occurrence of death, loss to follow-up, complete discontinuation of all systemic therapies (defined as a gap of at least 90 days), or 5 years of follow-up.
• The stabilised inverse probability of treatment weights was used to account for baseline confounding, and the stabilised inverse probability of censoring weights was used to account for time-varying confounding and loss to follow-up.

TAKEAWAY:

• At 5 years, the mean PASI score was 2.0 (95% CI, 1.2-2.7) for biologic initiators compared to 4.7 (95% CI, 4.0-5.4) for patients following the standard of care, and the mean DLQI score was 3.5 (95% CI, 1.3-5.7) compared to 5.6 (95% CI, 4.2-7.0), respectively.
• The cumulative rate of achieving complete skin clearance (a PASI score = 0) was 58.6% (95% CI, 52.5%-64.8%) in patients starting with biologics vs 32.1% (95% CI, 30.4%-33.9%) in those following the standard of care, with biologic initiators showing a higher likelihood of achieving a PASI score of 0 (hazard ratio [HR], 2.85; 95% CI, 2.34-3.47).
• The cumulative risk of developing new chronic comorbidities over 5 years was 47.5% (95% CI, 40.6%-54.9%) in the biologic initiator group vs 54.3% (95% CI, 52.4%-56.2%) in the standard-of-care group, with biologic initiators showing a significantly lower rate of developing new chronic comorbidities (HR, 0.72; 95% CI, 0.58-0.89).
• Patients starting with biologics had a lower rate of developing mental disorders (HR, 0.64; 95% CI, 0.44-0.94) and hepatic disorders (HR, 0.54; 95% CI, 0.38-0.76) than those following the standard of care.

IN PRACTICE:

"The findings support a potential shift toward earlier use of biologics in the treatment pathway to improve long-term patient health," the authors wrote.

SOURCE:

This study was led by Duc Binh Phan, Dermatology Centre, Northern Care Alliance NHS Foundation Trust and Division of Musculoskeletal and Dermatological Sciences, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, England. It was published online on March 16, 2026, in the British Journal of Dermatology.

LIMITATIONS:

Residual confounding from socioeconomic status, health literacy, patient advocacy, and access to specialist care remained, and alcohol consumption was not fully balanced after weighting. Before weighting, patients starting with biologics were older, had more severe and longer-standing disease, and had a higher comorbidity burden, indicating confounding by indication. Outcome availability (particularly PASI and DLQI assessments) varied over time, limiting precision. The group initiating with biologics was small. Comorbidities were identified from routine clinical records and may have underestimated milder conditions.

DISCLOSURES:

This research was supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre. One author was supported in part by the Manchester NIHR Biomedical Research Centre and along with four other authors reported receiving grants and having other ties with various other sources, including AbbVie, Almirall, and Artax. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.