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 Psoriasis Area and Severity Index (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 multicentre setting. Methods This multicentre retrospective real-life study included patients treated with bimekizumab, brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab or ustekinumab at 23 Italian referral centres. Cumulative benefit was assessed by the AUC of PASI 100 (100% improvement from baseline) from week 0 to week 52, and days free of disease (PASI 100). Analyses included subgroup evaluations by biologic-naive 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 < 0.001). The advantage was consistent across subgroups, with 216 days free of disease in biologic-naive and 184 in biologic-experienced patients. No significant differences were found between bimekizumab and ixekizumab, brodalumab or risankizumab. Conclusions In this multicentre real-life study, bimekizumab showed exploratory evidence of 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.