Cutaneous Psoriasis and Symptoms (Itch, Pain and Burning Sensation): A Monocentric Retrospective Study on 299 Patients in Italy

Background: Psoriasis is a chronic inflammatory disease with significant physical and psychological impacts. Among its forms, moderate-to-severe psoriasis often requires systemic treatment. Despite the availability of biologics, treatment discontinuation remains a concern. Understanding the reasons behind discontinuation is essential for optimizing therapeutic strategies and patient management. Methods: This retrospective study analyzed data from 255 patients with moderate-to-severe psoriasis treated with biologics between January 2019 and June 2023 at the Dermatology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna. The primary objective was to assess the frequency and causes of treatment discontinuation. Data on demographic and clinical characteristics, previous treatments, type and duration of biologic therapy, and reasons for discontinuation were collected and analyzed. Results: Out of 255 patients, 107 (42%) discontinued at least one biologic during the study period. The most frequently discontinued agents were anti-IL17 drugs (40.2%), followed by anti-IL12/23 (21.5%), anti-IL23 (21.5%), and anti-TNFα (16.8%). The main reasons for discontinuation were primary inefficacy (35.5%) and secondary inefficacy (30.8%). Adverse events accounted for 12.1% of discontinuations, while other reasons (including patient decision and comorbidities) represented 21.6%. Older patients showed a higher discontinuation rate, and female patients reported a greater frequency of adverse events. A higher number of previous biologic therapies was associated with increased risk of discontinuation. Conclusions: Biologic discontinuation in patients with moderate-to-severe psoriasis remains a frequent challenge, primarily due to inefficacy. Patient age, gender, and treatment history influence discontinuation patterns. These findings highlight the need for personalized therapeutic approaches and closer monitoring to improve long-term treatment adherence and outcomes.