The Impact of Obesity on Response to Secukinumab in Pediatric Plaque Psoriasis: A Real‐World Study

Background Obesity is a prevalent comorbidity in children with pediatric psoriasis and is known to influence treatment outcomes in adults. In China, secukinumab, an anti‐IL‐17A biologic, is available for treating pediatric psoriasis. However, the impact of obesity on the effectiveness of secukinumab in children remains unclear. Objective To evaluate the effect of obesity on the clinical response to secukinumab in pediatric patients with plaque psoriasis. Methods This retrospective cohort study included 70 children with plaque psoriasis treated with secukinumab for at least 52 weeks. Data on demographics, body mass index (BMI), disease duration, prior systemic therapy, and disease severity were collected. Patients were stratified by BMI into a nonobese group (normal: < 85th percentile; overweight: 85th–< 95th percentile) and an obese group (≥ 95th percentile) based on age‐ and sex‐specific percentiles from national pediatric references. Treatment efficacy, measured by PASI100, PASI90, PASI75, and Investigator’s Global Assessment (IGA) 0/1 responses, was assessed at baseline and Weeks 4, 12, 36, and 52, when available. Mixed‐effects models and generalized estimating equations were used to analyze the impact of BMI or BMI status on treatment efficacy. Results Of the 70 children included, 70.5% and 80.3% achieved PASI100 and PASI90 at weeks 24, respectively, with efficacy sustained through 52 weeks. Nonobese children had significantly higher PASI100 responses compared to obese children at Weeks 12 (69.8% vs. 35.7%) and 24 (76.6% vs. 50.0%, both p < 0.05). After adjusting for confounders, obesity was associated with a reduced likelihood of achieving PASI100 (OR = 0.32, 95% CI 0.13–0.81) and PASI90 (OR = 0.23, 95% CI 0.06–0.83). Higher BMI independently reduced the odds of achieving PASI100 (OR = 0.90, 95% CI 0.81–1.00, p = 0.043). Conclusion Secukinumab is effective in treating children with plaque psoriasis; however, obesity and higher BMI negatively impact clinical outcomes.