Comparison between super-responders and non-super-responders in psoriasis under adalimumab treatment: a real-life cohort study on the effectiveness and drug survival over one-year

Figures & data

Table 1. Baseline demographic and clinical characteristics.

Variables	SR group (n = 15)	NSR group (n = 55)	p Value
Age, years	41.6 ± 15.9	39.7 ± 12.5	.62
Male sex, n (%)	11 (73.3%)	35 (63.6%)	.48
Age of onset, years	28.2 ± 9.3	26.3 ± 12.6	.50
Disease duration, years	13.8 ± 11.4	14.2 ± 9.2	.47
Psoriasis arthritis, n (%)	5 (33.3%)	20 (40.0%)	.64
Weight, kg	66.0 ± 11.9	67.2 ± 10.1	.71
BMI, kg m^−2	23.8 ± 4.1	24.0 ± 2.9	.80
Waist, cm	82.0 (79.0–90.0)	87.0 (80.0–94.0)	.32
Waist/hip	0.9 ± 0.1	0.9 ± 0.1	.25
Cigarette use, n (%)
Never	8 (53.3%)	32 (58.2%)	.74
Current smoker or ex-smoker	7 (46.7%)	23 (41.8%)
Alcohol drinker, n (%)
Never	11 (73.3%)	45 (81.8%)	.72
Current drinker or ex-drinker	4 (26.7%)	10 (18.2%)
CCI ≥1, n (%)	3 (20.0%)	34 (61.8%)	<.01
Mets, n (%)	3 (20.0%)	18 (32.7%)	.53
Use of biologic treatment, n (%)	0	16 (29.1%)	.04
PASI score	10.8 (6.4–19.0)	7.9 (6.7–16.1)	.81
DLQI score	8.0 (3.3–13)	5.5 (1.8–13)	.57
Laboratory assessments
Fasting glucose, mmol/L	5.3 (5.0–5.7)	5.4 (4.9–5.9)	.84
Cholesterol, mmol/L	1.4 (0.9–2.1)	1.5 (0.9–2.5)	.46
HDL cholesterol, mmol/L	1.2 (1.1–1.4)	1.1 (1.0–1.3)	.10
Uric acid, μmol/L	326.6 (266.0–396.8)	352.0 (296.9–435.6)	.43
CRP, mg/L	1.1 (0.6–4.4)	1.7 (1.1–3.6)	.30

Note: SR: super responder; NSR: non-super responder; BMI: body mass index; CCI: Charlson Co-morbidity Index; Mets: metabolic syndrome. PASI: psoriasis area and severity index; BSA: body surface area; DLQI: dermatology life quality index; HDL: high-density lipoprotein; CRP: C-reactive protein. In bold statistical significant values (p < .05).

Table 2. Safety outcomes between SR and NSR.

Adverse events	All (n = 70)	SR (n = 15)	NSR (n = 55)
Any adverse event	10 (14.3%)	2 (13.3%)	8 (14.5%)
Serious adverse event	0	0	0
Discontinuation treatment because of AEs	2 (2.9%)	0	2 (3.6%)
Infections	4 (5.7%)	0	4 (7.3%)
Upper respiratory tract infection	1 (1.4%)	0	1 (1.8%)
Nasopharyngitis	1 (1.4%)	0	1 (1.8%)
Pharyngitis	1 (1.4%)	0	1 (1.8%)
Conjunctivitis	1 (1.4%)	0	1 (1.8%)
Cough	3 (4.3%)	0	3 (5.5%)
Injection site reactions	2 (2.9%)	1 (6.7%)	1 (1.8%)
Abnormal LFTs	2 (2.9%)	1 (6.7%)	1 (1.8%)
Gained weight ≥5kg	1 (1.4%)	0	1 (1.8%)
Arthralgia	1 (1.4%)	1 (6.7%)	0

Note: SR: super responder; NSR: non-super responder; AEs: adverse events; LFTs: liver function test.

Figure 1. Comparison of PASI response at weeks 4, 12, 24, and 52 between SR and NSR. ^bIn the NSR group, one patient discontinued the adalimumab treatment and one patient switched to secukinumab. ^cIn the NSR group, another four patients switched to secukinumab (n = 3) and stekinumab (n = 1), respectively. Among 15 super- responders, 2 (13.3%) patients had a mild degree of psoriasis (PASI = 0.5; PASI =0.6) at week 24 and reached a PASI 100 response again at week 32. ^dIn the SR group, one patient discontinued the adalimumab treatment, while in the NSR group, eight additional patients, discontinued (n = 4) and switched to IL-17A inhibitors (seckinumab, n = 2; ixekizumab,n = 2), respectively. SR: super responder; NSR: non-super responder; PASI: psoriasis area and severity index. **p-value < .01; ***p-value < .001.

Figure 2. Forest plot of variables associated with the likelihood of reaching PASI 90 and PASI 100 at week 24 and week 52. HDL: high-density lipoprotein; CCI: Charlson Co-morbidity Index; PASI: psoriasis area and severity index; Y/N: yes versus no; M/F: male versus female.

Table 3. Univariate logistic regression analysis: potential predictors for SR.

	Week 24		Week 52
Variables	PASI 90 (Y/N)	PASI 100 (Y/N)	PASI 90 (Y/N)	PASI 100 (Y/N)
Sex (M/F)	0.31 (0.10–0.91)	0.30 (0.08–0.97)	0.31 (0.10–0.91)	0.28 (0.08–0.97)
CCI ≥ 1 (Y/N)	0.51 (0.20–1.33)	0.33 (0.12–0.94)	0.51 (0.20–1.33)	0.33 (0.12–0.94)
MetS (Y/N)	0.20 (0.06–0.68)	0.36 (0.11–1.23)	0.20 (0.06–0.68)	0.36 (0.11–1.23)
Low HDL* (Y/N)	0.16 (0.05–0.47)	0.32 (0.11–0.93)	0.16 (0.05–0.47)	0.32 (0.10–0.93)
Nonnaive/bionaive	0.91 (0.01–0.75)	0.00 (0.00–0.00)	0.74 (0.01–0.61)	0.00 (0.00–0.00)

  Note: CCI: Charlson Co-morbidity Index; Mets: metabolic syndrome; HDL: high-density lipoprotein; PASI: psoriasis area and severity index; Y/N: yes versus no; M/F: male versus female. *Low HDL was defined as <1.03 mmol/L for men and <1.29 mmol/L for women.

Figure 3. (a) Adalimumab survival over time between SR and NSR. (b) Adalimumab survival over time between SR-bio-naïve, NSR-bio-naïve and NSR-nonnaïve. SR: super responder; NSR: non-super responder.

Figure 4. Early effectiveness of NSR and SR after IL-17A inhibitors switching therapy. ^aPatients who switched to SEC were administrated subcutaneously (150 mg for patients < 60 kg and 300 mg for patients > 60 kg) at weeks 0, 1, 2, 3, and 4, and then every four weeks. ^bThe dosing regimen for patients who switching to IXE is 160mg at week 0, then 80 mg every 2 weeks for 12 weeks. ^cIn ©, patients 1 and 2 switched to IXE, patients 3–5 switched to SEC. SR: super responder; NSR: non-super responder; IXE: ixekizumab; SEC: secukinumab.