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During follow-up, a DTS was implemented for 93 (10-9%) of 850 patients (dose reduction for six patients and interval prolongation for 87 patients). Https://doi.org/10.1093/bjd/ljac024 Dear Editor, While biologic therapies have become a staple of treatment for patients with moderate-to-severe psoriasis, there is a lack of data available to assess biologic maintenance-management strategies for psoriasis. [Extracted from the article]

Background: Obesity is associated with an increased risk of psoriasis. Objective: In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis. Methods: In this cohort study, we compared obese (BMI ≥30 kg/m2) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival. Results: A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36–56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients (p < 2.10–4) and was worse for obese than non-obese patients for UST (p = 0.009) and ETA (p = 0.02), with no difference for ADA (p = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23–2.96], p = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04–2.19). Conclusion: This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes. [ABSTRACT FROM AUTHOR]

Background: Little is known about phototype and the response to systemic treatment in psoriasis., Objectives: To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype., Methods: We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index (DLQI) 0/1., Results: Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, and more frequently initiated ustekinumab. Patients in the V-VI group maintained the initial biologic prescribed as did the other phototype groups, even though the proportion of patients reaching PASI 90 and DLQI 0/1 at 12 months was lower in this group than the other groups., Conclusions: Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. The phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient., Competing Interests: Conflicts of interest F.T. is Head of the Clinical Research Unit at Pitié-Salpêtrière Hospital and the Centre de Pharmacoepidemiologie (Cephepi) (Pharmacoepidemiology Centre) of the Assistance Publique–Hôpitaux de Paris (Paris Hospitals); she has received research funding, grants and fees for consultancy activities from a large number of pharmaceutical companies that have contributed to employee salaries (but no personal remuneration for F.T.). M.V. has undertaken activities as a paid consultant, advisor or speaker for AbbVie, Arrow, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Galderma, Janssen, LEO Pharma, Lilly, medac, MSD, Novartis and Pfizer. M.B.-B. offers a consultancy service and is an investigator for AbbVie, Amgen, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis and Pfizer. N.B. has been an investigator for Novartis and Pfizer; she is a consultant for Janssen and has received speaker remuneration from Janssen. P.J. is a consultant for GSK, Lilly, Principia Biopharma, Roche and Sanofi Aventis. D.J. is a consultant for AbbVie, Biogen, Celgene, Fresenius Kabi, Janssen, Lilly, medac, Merck Sharp & Dohme, Novartis, Pfizer and UCB. E.M. is a consultant for AbbVie, Janssen, Novartis and Pfizer; she has also been an investigator for AbbVie, Amgen, AstraZeneca, LEO Pharma, Novartis and Pfizer; and has received speaker remuneration from AbbVie, Janssen, Novartis and Pfizer. C.P. has been an investigator and consultant for AbbVie, Amgen, Boehringer Ingelheim, Celgene, GSK, Janssen, LEO Pharma, Lilly, Novartis and Pfizer. M.-A.R. is a consultant for AbbVie, BMS, Galderma, Janssen, LEO Pharma, Merck, Novartis, Pfizer and Pierre Fabre. H.B. has undertaken activities as a paid consultant, advisor or speaker for AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Sun Pharmaceuticals and UCB; he has also received grant funding from Pfizer. The other authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)