Biologic Efficacy by BMI in Moderate‐To‐Severe Psoriasis: A Real‐World Cohort Study

ABSTRACT Obesity reduces response to biologic therapy in psoriasis, but comparative evidence across drug classes in Chinese patients is limited. A real‐world cohort of 891 adults with moderate‐to‐severe psoriasis initiating biologics between 2020 and 2025 was divided by baseline BMI (< 24 vs. ≥ 24 kg/m 2 ). PASI90 achievement at 2, 4, 6 and 12 months and drug survival were compared amongst IL‐17, IL‐23 and TNF‐α inhibitors. Amongst IL‐17 users, PASI90 rates in the non‐overweight group were consistently higher at 4, 6 and 12 months (all p < 0.05), whereas no BMI‐related differences were seen with TNF‐α or IL‐23 blockade. Within the non‐overweight stratum, IL‐17 and IL‐23 agents outperformed TNF‐α inhibitors at month 6 and yielded fewer switches ( p < 0.05). In the overweight/obese stratum, IL‐23 blockade achieved the highest PASI90 rates and longest drug survival versus both IL‐17 and TNF‐α inhibitors ( p < 0.05). In this real‐world cohort of Chinese psoriasis patients, BMI was observed to correlate with biologic effectiveness in a drug‐specific manner. Our findings suggest that whilst IL‐17 or IL‐23 inhibitors showed favourable outcomes for non‐overweight individuals, IL‐23 blockade may be associated with a more sustained response in those categorised as overweight or obese.