Impact of BMI and Body Weight on Clinical Outcomes in Psoriasis: A Post Hoc Analysis of the RESOLVE Observational Study

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ABSTRACT Background Obesity is a known risk factor for psoriasis and has been implicated in reduced effectiveness of certain biologic treatments. While most studies examine the role of body mass index (BMI), less is known about the impact of absolute body weight on brodalumab outcomes, particularly in real‐world settings. Objectives This study aimed to evaluate the association of baseline body weight and BMI with the clinical effectiveness and patient‐reported outcomes (PROs) of brodalumab in patients with moderate‐to‐severe plaque psoriasis. Methods A post hoc analysis of the RESOLVE study‐a prospective, multicenter, single‐arm real‐world study conducted in Greece‐was performed. A total of 145 patients initiating brodalumab were followed for 52 weeks. Clinical outcomes [Psoriasis Area and Severity Index (PASI), static Physician's Global Assessment (sPGA)] and PROs [Dermatology Life Quality Index (DLQI), Patient Global Assessment (PaGA), Treatment Satisfaction Questionnaire for Medication (TSQM‐9)] were compared across BMI categories and body weight groups (< 100 kg vs. ≥ 100 kg). Longitudinal population‐averaged models were used to assess longitudinal treatment responses. Results Patients ≥ 100 kg exhibited delayed clinical responses, with significantly lower PASI90, PASI100, and sPGA 0 rates at Weeks 24‐Weeks 52 compared to those < 100 kg. In contrast, BMI‐based differences were inconsistent. Generalized estimating equations (GEE) modeling showed significantly slower odds of achieving PASI ≤ 3 in the ≥ 100 kg group at Week 24, although long‐term improvement was observed in all patients. PROs revealed smaller early DLQI and TSQM‐9 improvements in heavier patients, though differences for TSQM‐9 resolved by Weeks 52. PaGA “free of symptoms” responses were also numerically lower in ≥ 100 kg patients early on, converging at 1 year. Conclusions The results demonstrated that a body weight threshold of ≥ 100 kg may be a more sensitive predictor than BMI for identifying psoriasis patients at risk of delayed or reduced brodalumab response. Thus, these findings may contribute to patient counselling and management.

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