Observational case series on a group of psoriasis patients who failed to respond to any TNF blockers

Introduction: Data that can identify the patients who will not respond to anti-TNF agents are sparse. Therefore, the authors wished to describe specific clinical factors that could be associated with a non-response to any available TNF blockers in patients with psoriasis. Methods: A retrospective observational study was performed through the mailing of a questionnaire to five departments of Dermatology. Only psoriasis patients who were not responsive to all available anti-TNF agents (etanercept, infliximab and adalimumab), whatever the chronology of their use, were included. Results: Twenty-two patients were included. Forty patients (64%) did not work at the time of the study and 12 (55%) qualified for Social Security Disability Allowance. Forty patients (64%) were considered as "overweight". Fifty-nine percent of patients were smokers. Antinuclear antibodies were positive in 9 out of 16 patients tested (56%) at the time of non-response. Ustekinumab, which was further introduced in 19 patients, led to PASI 75 in all (94%) but one patient. Conclusion: The data identified different clinical factors associated with a non-response to any available TNF blockers. Furthermore, non-responder patients were highly responsive to ustekinumab suggesting that in few psoriasis patients, TNF blockade is not the best target and other TNF-independent signaling pathway should be considered.