Prevalence and characterization of treatment-refractory psoriasis and super-responders to biologic treatment: a nationwide study

N Loft, A Egeberg, M K Rasmussen, L E Bryld, C V Nissen, T N Dam, K K Ajgeiy, L Iversen, L Skov


INTRODUCTION: Treatment with biologics often leads to clearance of psoriasis. However, some patients do repeatedly fail to respond and/or lose an achieved response (treatment refractory) to the biologic, whereas other patients achieve excellent response to one biologic and remain clear of psoriasis for several years (super-responders).

OBJECTIVE: To identify and characterize patients with treatment refractory psoriasis and patients who are super-responders to biologic treatment.

MATERIAL AND METHODS: Patients registered in DERMBIO between January 2007 and November 2019 were included. Patients were categorized as being treatment refractory if they had had treatment failure to ≥3 biologics targeting ≥2 different pathways. Super-responders were patients treated with their first biologic for minimum 5 years without an absolute psoriasis area and severity index (PASI) > 3 between 6 months and 5 years of treatment. All remaining patients from DERMBIO served as comparators.

RESULTS: In total, 3280 patients were included with a mean age of 45.0 years. 1221 (37%) of the patients were females. Of the included patients, 214 (6.5%) were categorized as treatment refractory and 207 (6.3%) were categorized as super-responders. Treatment refractory patients had higher mean body weight (100.6 kg vs. 90.6 kg, P < 0.0001) and higher mean BMI (32.2 vs. 29.4, P < 0.0001) compared with the rest of patients in DERMBIO. Super-responders had higher socioeconomic status and fewer comorbidities compared with the comparator group (P < 0.0001).

CONCLUSION: A small proportion of patients with psoriasis treated with biologics are either super-responders or treatment refractory. Treatment refractory patients have higher body weight, whereas super-responders have fewer comorbidities and higher socioeconomic status.

Original languageEnglish
JournalJournal of the European Academy of Dermatology and Venereology : JEADV
Issue number8
Pages (from-to)1284-1291
Number of pages8
Publication statusPublished - Aug 2022


  • Biological Products/adverse effects
  • Body Weight
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Psoriasis
  • Severity of Illness Index
  • Treatment Outcome


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