Cumulative clinical benefits of biologic treatments in patients with moderate-to-severe psoriasis: an Italian real-life experience - IL PSO (Italian Landscape Psoriasis)

Background: Psoriasis is a chronic inflammatory disease associated with significant long-term cumulative life course impairment. Achieving rapid relief from psoriasis is a crucial aspect of an effective treatment, as it helps patients manage their daily discomfort, including pain, itching, embarrassment, and other negative impacts of the disease. Cumulative clinical benefit, measured as the area under the curve (AUC) of PASI responses and days free of disease, offers a comprehensive assessment of treatment efficacy over time. Objectives: To evaluate the cumulative clinical benefits of biologic therapies in patients with moderate-to-severe plaque psoriasis in a real-world Italian multicenter setting. Methods: This multicenter retrospective real-life study included patients treated with bimekizumab, brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, or ustekinumab at 23 Italian referral centers. Cumulative benefit was assessed by AUC of PASI100 from week 0 to 52, and days free of disease (PASI100). Analyses included subgroup evaluations by bio-naïve status and baseline PASI (≤10 vs >10). Results: Among 1017 patients, bimekizumab showed the highest cumulative clinical benefit, with a mean of 203 days free of disease. It was significantly superior to guselkumab (p<0.05), secukinumab (p<0.01), ustekinumab (p<0.01), and tildrakizumab (p<0.0001). The advantage was consistent across subgroups, with 216 days free of disease in bio-naïve and 184 in bio-experienced patients. No significant differences were found between bimekizumab and ixekizumab, brodalumab, or risankizumab. Conclusions: In this multicenter real-life study, bimekizumab provides exploratory evidence on the cumulative clinical benefit of biologics in moderate-to-severe psoriasis. These findings highlight the importance of cumulative endpoints and individualized treatment strategies in daily practice.