Clinical predictors of early treatment response across systemic therapies in psoriasis: a prospective cohort study

Background Baseline clinical factors may help estimate early response in psoriasis, but real world evidence across biologics, methotrexate, and phototherapy remains limited. We used SPEECH registry data to evaluate factors associated with Physician Global Assessment (PGA) ≤ 1 at week 12.Methods Patients initiating biologics, methotrexate, or phototherapy with week 12 PGA data were included. The primary endpoint was week 12 PGA ≤ 1. Separate multivariable logistic regression models evaluated baseline factors, and restricted cubic spline (RCS) models evaluated associations between body mass index (BMI) and response.Results Among 998 patients, 478 received biologics, 262 methotrexate, and 258 phototherapy. Response rates were 70.1%, 45.8%, and 54.7%, respectively. Obesity was associated with lower response odds in biologics and methotrexate, but not clearly in phototherapy. In biologics, family history was associated with higher response odds, whereas prior biologic treatment was associated with lower odds. Higher baseline PGA was associated with lower response odds in phototherapy. RCS analysis suggested that associations between BMI and response were most evident in biologics, borderline in methotrexate, and not apparent in phototherapy.Conclusions Baseline predictors differed across treatment groups. Obesity/BMI appeared more relevant to response in biologics and methotrexate, whereas baseline PGA appeared more relevant in phototherapy.