Earlier Biologic Intervention for Younger Patients with Psoriasis Improves Outcomes

Yasmina Behlock

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Earlier intervention with effective biologic treatments among younger patients with psoriasis improves outcomes, according to recent findings, as medication shortly after initial lesion onset results in better responses.¹

These conclusions resulted from new research authored by a team led by Yasmina Behlock, a medical student from the department of dermatology at Brussels University Hospital in Belgium. Behlock et al. noted the importance of their analysis, highlighting the devastating effect of the inflammatory skin disease on sufferers’ physical and emotional well-being as well as life quality.²

“The primary objective is to study the efficacy of diverse treatment modalities using long-term, real-life data,” Behlock and colleagues wrote. “Patients must meet specific criteria, such as treatment with conventional immunosuppressives, before having access to highly efficacious biological therapy. We aimed to find out: Is this truly the best approach to patient care?”¹

Analyzing the Impact of Biologic Interventions for Psoriasis

The investigative team 205 patients’ data, including 104 individuals who were already part of the Belgian Psoriasis Registry, conducting their analysis retrospectively. For inclusion in the team’s assessment, those considered as participants were required to have a Psoriasis Area and Severity Index (PASI) score recorded in their medical file and required to have attended follow-up consultations either prior to 35 weeks post-inclusion or following the 40-week, post-inclusion mark.

Those considered for inclusion were not involved if they did not provide consent, were not enrolled in the Registry, or were shown to have incomplete medical records. Individuals who had psoriasis and were already included in the Registry were evaluated through routine dermatology follow-up interactions conducted at Erasmus Hospital.

The study was conducted in a set of 2 phases. One was a retrospective segment, during which invesrtigators looked at individuals from the early stages of the Registry analysis who had attended follow-up meeting but had not completed the follow-up questionnaire. The second was a prospective segment, during which subjects who were currently being assessed at Erasmus Hospital filled out a follow-up questionnaire along with the assistance of their physician.

The investigative team structured their questionnaire in 2 sections, with 1 completed by the clinician and the other filled out by the participant. During the analysis’s prospective phase, 101 participants who had provided consent to participate, attended follow-ups, and fully completed the follow-up form were evaluated. It was noted by the team that this was done irrespective of their treatment type or their disease activity.

The research team’s data analysis included the use of means with standard deviations or medians with interquartile ranges for continuous variables. They reported categorical variables as numbers and percentages. The team carried out group comparisons via statistical tests such as the Fisher’s exact test, Mann–Whitney test, t-test, and Chi-square test. The team considered a two-sided P-value of less than .05 as statistically significant.

Treatment response among the 205 subjects evaluated was based on at least 75% improvement in subjects' PASI scores from the initial visit to the follow-up, also referred to as a PASI 75 response. Overall, the investigators concluded that 47% of participants in the analysis attained a PASI 75 response.

They noted that 50% of subjects who received biologic therapy, 30.5% of those treated with systemic conventional drugs, and 32.25% of subjects treated with topicals or phototherapy were able, in the short term, to achieve a PASI 75 response.

Long-term follow-up evaluation by the investigative team yielded an observed increased in response rates among those on biologics and among those given systemic conventional medication. Specifically, it was noted that 55.5% attained PASI 75. The team also found that those who initiated treatment shortly following the onset of their initial lesions had significantly better responses (P < .0001).

“In conclusion, this study adds novel considerations to the literature,” they wrote. “We observed the importance of promptly treating patients after the onset of their first lesions to ensure the best possible response, particularly in younger patients.”¹

References

1. Behlock, Y., Dandoy, C., Willaert, F., Debusscher, C., Njimi, H., Benhadou, F., del Marmol, V. and White, J.M.L. (2025), Early Use of Beneficial Biological Therapy on Younger Psoriasis Patients: Could a ‘Step-Down’ Therapy Approach Be More Effective?. Int J Dermatol. https://doi.org/10.1111/ijd.17704.

2. R. Parisi, D. P. Symmons, C. E. Griffiths, D. M. Ashcroft, Identification, Management of P, and Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team, “Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence,” Journal of Investigative Dermatology 133, no. 2 (2013): 377–385, https://doi.org/10.1038/jid.2012.339.