Among patients with psoriasis and obesity, significant negative effects were noted for response to interleukin-17 and interleukin-12/23 inhibitors, but not for tumor necrosis factor-alpha or interleukin-23 inhibitors.
Obesity may be associated with lower treatment response to biologic therapies for psoriasis, particularly interleukin (IL)-17 and IL-12/23 inhibitors, suggesting that BMI should be considered when selecting biologic therapy and counseling patients, according to results of a study published in the Journal of Dermatological Treatment
Researchers conducted a systematic review and meta-analysis to evaluate the effect of obesity on the efficacy of biologic treatments across different drug classes. The researchers searched 4 databases from inception through March 2026 for randomized controlled trials and observational studies comparing the efficacy of biologic treatments in patients with psoriasis with obesity vs without obesity. Eligible studies reported Psoriasis Area and Severity Index (PASI) 75, PASI 90, or PASI 100 outcomes stratified by obesity status. Relative risks (RRs) with 95% CIs were pooled using fixed- or random-effects models, with subgroup analyses, meta-regression, sensitivity analyses, and publication bias assessments performed.
A total of 12 studies including 4200 patients were analyzed. Patients with obesity had significantly lower response rates for PASI 90 than patients without obesity (RR, 0.64; 95% CI, 0.55-0.76; I² =72%; P <.001), although this association was no longer significant after trim-and-fill correction for publication bias (pooled RR, 0.79; 95% CI, 0.58-1.08). Significant reductions in PASI 90 response were observed with IL-17 inhibitors (RR, 0.57; 95% CI, 0.43-0.75; I² =75.3%; P <.001) and IL-12/23 inhibitors (RR, 0.43; 95% CI, 0.26-0.70; I² =0%; P =.551), whereas tumor necrosis factor alpha inhibitors (RR, 0.63; 95% CI, 0.32-1.23; I² =0%; P <.001) and IL-23 inhibitors (RR, 0.53; 95% CI, 0.13-2.12; I² =79.6%; P =.027) showed similar trends but did not reach statistical significance.
Weight status should be considered as one of multiple factors when selecting biologics, but current evidence does not support treatment selection based solely on obesity
Obesity was also associated with lower PASI 75 responses (RR, 0.52; 95% CI, 0.34-0.80; I² =69.6%; P <.001), which remained significant after publication bias correction (RR, 0.48; 95% CI, 0.28-0.82). A lower PASI 100 response rate was also observed among patients with obesity (RR, 0.42; 95% CI, 0.31-0.58; P <.001). Meta-regression identified biologic class (P =.031), study design (P =.001), geographic region (P =.001), mean BMI (P =.001), and obesity prevalence (P =.022) as significant contributors to effect size.
Study limitations include the predominance of observational studies with potential residual confounding, lack of individual patient data preventing adjustment for disease severity and prior treatment, and substantial heterogeneity in obesity definitions and BMI thresholds across studies, particularly between Western and Asian populations
The researchers concluded, “This systematic review and meta‑analysis found that obesity may be associated with diminished response to biologic therapy in psoriasis.” They added, “Weight status should be considered as one of multiple factors when selecting biologics, but current evidence does not support treatment selection based solely on obesity.”
Zhou W, Xu Z, Yu H, Wang X, Li L, Pan X.Efficacy differences of biologic agents targeting different pathways in obese patients with psoriasis: a systematic review and meta-analysis. J Dermatolog Treat. Published online July 21, 2026. doi:10.1080/09546634.2026.2705161
