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The association between HLA-C*06:02 and age of psoriasis onset on response to biologic treatment
By Ella Dixon
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Biologic treatments have been shown to be highly effective for some individuals with psoriasis, but response to biologic treatment may vary.1 There are no clear guidelines on biologic selection, which can lead to a trial-and-error approach to treatment.1 Here, we summarize a study published by Alabas et al. in the British Journal of Dermatology investigating the association between HLA-C*06:02 and the age of psoriasis onset, with response to biologic treatment.1
Study design1
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Data were analyzed for patients ≥16 years of age, on a first course of adalimumab, etanercept, secukinumab, or ustekinumab with ≥6 months’ follow-up and who were registered to the British Association of Dermatologist Biologics and Immunomodulators Register (BADBIR) between 2007 and 2022 with HLA-C*06:02 information available.
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Early-onset psoriasis was defined as patients who developed psoriasis ≤ 40 years of age and late-onset as patients who developed psoriasis >40 years of age.
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Only patients aged 50 years or above at enrollment were categorized with age of onset.
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Response to biologic treatment was analyzed in terms of biologic survival, defined as discontinuation due to ineffectiveness or adverse events.
Patient population1
- In total, 4,250 patients were were stratified by age at psoriasis onset (2,929 were classified with early-onset psoriasis and 1,321 with late-onset psoriasis).
- A total of 3,094 patients were stratified by HLA-C*06:02 status (1,603 were HLA-C*06:02 positive and 1,491 were HLA-C*06:02 negative).
Key findings1
- Age of psoriasis onset did not affect treatment discontinuation due to biologic ineffectiveness.
- Patients who were positive for HLA-C*06:02 were less likely to discontinue ustekinumab due to ineffectiveness compared with those who were HLA-C*06:02 negative (Table 1).
- There was no difference in time until discontinuation due to adverse events when comparing the age-of-onset groups or HLA-C*06:02 status (Table 1).
Table 1. Adjusted hazard ratios for ineffectiveness and adverse events for adalimumab, etanercept, secukinumab, and ustekinumab *
|
|
Ineffectiveness |
AEs |
||
|---|---|---|---|---|
|
aHR |
P value |
aHR |
P value |
|
|
Age at psoriasis onset |
|
|
|
|
|
Early-onset (reference) |
||||
|
Adalimumab |
1.14 |
0.180 |
0.81 |
0.077 |
|
Etanercept |
1.13 |
0.410 |
0.76 |
0.241 |
|
Secukinumab |
1.20 |
0.394 |
1.14 |
0.619 |
|
Ustekinumab |
0.96 |
0.754 |
1.24 |
0.163 |
|
HLA-C*06:02 |
|
|
|
|
|
HLA-C*06:02 negative (reference) |
||||
|
Adalimumab |
0.85 |
0.083 |
1.13 |
0.356 |
|
Etanercept |
0.98 |
0.864 |
1.62 |
0.057 |
|
Secukinumab |
1.00 |
1.000 |
1.71 |
0.297 |
|
Ustekinumab |
0.56 |
<0.001 |
0.81 |
0.279 |
|
AE, adverse event; aHR, adjusted hazard ratio. *Adapted from Alabas et al.1 |
||||
|
Key learnings |
|
- Alabas OA, Mason KJ, Yiu Z. The association of age at psoriasis onset and HLA-C*06:02 with biologic survival in patients with moderate-to-severe psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). Br J Dermatol. Online ahead of print. DOI: 10.1093/bjd/ljad481
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