Obesity impacts both the clinical management and therapeutic strategies for psoriasis. This study aims to describe the use of biological medicines in treating obese patients with moderate-to-severe psoriasis. We conducted a retrospective cohort study (2007-2022) of obese patients who initiated biological treatments for moderate-severe psoriasis. The primary outcome was the number of biological treatment lines required to achieve an optimal or adequate Psoriasis Area and Severity Index (PASI) score reduction. Secondary outcomes included the duration of biological use and reasons for discontinuation. We included 58 patients (mean age 50 years, body mass index [BMI] 35.9 kg/m2, psoriasis duration 16.5 years). Biological treatments enabled 77.6% (45) of patients to achieve an optimal response, and 87.9% (51) achieved an adequate response. The median time-to-response was 2-7 months, with the greatest improvements seen with adalimumab, etanercept, and ustekinumab. The primary reason for discontinuation was lack of effectiveness (50% of first-line treatments). This study suggests that systemic biologics are effective for obese psoriasis patients and emphasizes the need for close monitoring of reasons that lead to discontinuation. As biologics evolve, refining guidelines will be essential for optimizing psoriasis management in obese patients.
