Predictors of clinical response to biologics in psoriasis: A systematic review and meta‐analysis

BACKGROUND: Biologic therapies have revolutionized psoriasis management, yet inter-individual response varies significantly and reliable predictors of complete skin clearance remain unclear. OBJECTIVES: This study aimed to identify prognostic predictors of biologic efficacy in patients with psoriasis through a systematic review and meta-analysis. METHODS: We systematically searched four databases (from their inception to January 28, 2026). Studies were screened and data extracted per predefined criteria; quality was assessed using the Newcastle-Ottawa Scale (NOS), and analyses were performed in Stata 15.0. RESULTS: Thirty studies (n = 13,902) were included. Negative predictors of clearance included older age (odds ratio [OR] 0.99, 95% CI 0.98-0.99, p < 0.001), higher body mass index (OR 0.94, 95% CI 0.92-0.97, p < 0.001), comorbidities (OR 0.75, 95% CI 0.63-0.9, p = 0.002), and involvement of special areas (OR 0.71, 95% CI 0.56-0.89, p = 0.003). Conversely, a positive family history (OR 1.42, 95% CI 1.18-1.71, p < 0.001) emerged as a significant predictor associated with better outcomes. No significant associations were observed for other analysed variables. CONCLUSIONS: Older age, higher comorbidity burden, obesity, and special-site involvement are associated with poorer biologic response in psoriasis, whereas family history is associated with better outcomes. These readily available baseline factors facilitate phenotype-based risk stratification and may guide treatment selection in clinical practice.