Psoriasis and psoriatic arthritis are chronic immune-mediated diseases with a high risk of comorbid conditions, for which the use of genetically engineered biological drugs (GEBD) is the most effective modern approach. Choice of the optimal drug requires considering clinical and demographic factors, treatment line and presence of concomitant diseases.

MATERIAL AND METHODS

A retrospective analysis of data from 405 patients (268 men, 137 women; mean age 46.7 years) with psoriasis vulgaris (43%) and arthropathic psoriasis (57%) who were receiving GEBD was performed. The distribution by drugs, frequency of efficacy «escape», influence of therapy line and comorbid pathology was evaluated. Statistical processing included the calculation of relative values, medians, interquartile range and correlation analysis.

RESULTS

Netakimab was the most frequently prescribed agent (45.4%) with a minimum frequency of therapy «escape» effect equal 12.8%. Among the used classes of drugs, inhibitors of IL-23 (10.3%) and IL-17 (25.3%) had the most stable positive effect; at the same time, TNF-α inhibitors showed the highest frequency of loss of effect (54.9%). The first line of therapy had a median response of 93.0%, which decreased by 2—6 p.p. to the 3^rd—4^th lines. Metabolic syndrome (40.1%) and cardiovascular diseases (32.1%) were associated with lower response to therapy, especially in application of TNF inhibitors. The IL-17 and IL-23 inhibitors showed stable efficacy even in late administration and in patients with comorbid pathology.

DISCUSSION

The obtained results confirm the need for a personalized selection of GEBD considering the diagnosis, line of therapy and profile of comorbid pathology. Drug classes of IL-23 and IL-17 inhibitors are preferred in late lines and in patients with high cardiometabolic risk.

CONCLUSION

The implementation of a stratified approach to the choice of GEBD and early selection of the most effective drug can reduce the risk of «escape» effect and improve long-term treatment results.