Abstract / Summary
Abstract Background Multiple biologic failure (MBF) was defined by a standardised institutional rule: receipt of ≥ 3 biologics from ≥ 2 mechanistic classes, each administered for ≥ 3 months. We assessed factors associated with this treatment-pathway phenotype and compared early skin and quality-of-life outcomes. Methods This retrospective single-centre cohort included 545 adults with psoriasis, of whom 50 (9.2%) had clinician-recorded MBF. Multivariable logistic regression assessed associations with inflammatory comorbidities, cardiometabolic factors and overall comorbidity burden. Outcomes at weeks 12–16 included 90% improvement in Psoriasis Area and Severity Index (PASI90) and Dermatology Life Quality Index (DLQI) 0/1. Results MBF was independently associated with psoriatic arthritis (adjusted odds ratio [aOR] 4.25, 95% confidence interval [CI] 2.24–8.05), inflammatory bowel disease (aOR 6.94, 95% CI 1.85–26.02) and each additional comorbidity (aOR 1.34, 95% CI 1.12–1.61). The IBD estimate was based on 12 patients and was considered hypothesis-generating. PASI90 achievement was similar between groups (75.0% vs. 74.8%; aOR 0.85, 95% CI 0.37–1.94), whereas DLQI 0/1 was less frequent with MBF (64.4% vs. 80.9%; aOR 0.29, 95% CI 0.13–0.62). Conclusion Clinician-recorded MBF was associated with inflammatory comorbidity, multimorbidity and persistent quality-of-life burden despite comparable early skin responses. These findings may reflect biological refractoriness, treatment-pathway complexity, or a combination of both, which cannot be fully disentangled within the present study design.