{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:11:04Z","timestamp":1793747464467,"version":"4.6.1"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patients with psoriasis who have failed multiple biologic drugs have been defined as \u201cmulti\u2010failure,\u201d although there are no clear data on the characteristics, comorbidities, and best treatment strategies for this population. Nowadays, given the next generation and the number of biologics available, patients are considered multi\u2010failure when \u22654 biologics fail to achieve a good response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Demographic characteristics and efficacy of anti\u2010interleukin drugs in multi\u2010failure patients were compared to a cohort of general psoriatic patients treated with IL\u201023 or IL\u201017 inhibitors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total 97 multi\u2010failure patients (\u22654 lines of biologics) were compared with 1,057 patients in the general cohort. The current drugs in the multi\u2010failure group were risankizumab (34), ixekizumab (23), guselkumab (21), brodalumab (7), tildrakizumab (5), ustekinumab (4), secukinumab (2), and certolizumab pegol (1). A significant difference was found in the multi\u2010failure cohort for age of psoriasis onset (mean 29.7 vs. 35.1,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), concurrent psoriatic arthritis (45.4 vs. 26.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), diabetes mellitus (30.9 vs. 10.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and cardiovascular comorbidity (54.6 vs. 39.8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). In multi\u2010failure patients, current biological therapy showed a good initial response (PASI 90 and 100 of 41.24 and 27.84%, respectively, at 16\u2009weeks); the response tended to decline after 40\u2009weeks. Anti\u2010IL\u201017 agents showed clinical superiority over IL\u201023 agents in terms of achieving PASI90 at 28\u2009weeks (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 40\u2009weeks (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007), after which they reached a plateau. In contrast, IL\u201023 agents showed a slower but progressive improvement that was maintained for up to 52\u2009weeks. A similar trend was also seen for PASI100 (28\u2009weeks\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.032; 40\u2009weeks\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.121).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The multi\u2010failure patient is characterized by many comorbidities and longstanding inflammatory disease that frequently precedes the introduction of systemic biologic therapy. Further studies are needed to identify more specific criteria that could be applied as a guideline by clinicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijd.17005","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T03:34:00Z","timestamp":1704425640000},"page":"351-358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Multi\u2010failure psoriasis patients: characterization of the patients and response to biological therapy in a multicenter Italian cohort"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3786-5070","authenticated-orcid":false,"given":"Riccardo","family":"Viola","sequence":"first","affiliation":[{"name":"Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe\u2010J) University of Bari \u201cAldo Moro\u201d  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7386-3219","authenticated-orcid":false,"given":"Luca","family":"Mastorino","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Dermatology Clinic University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1803-2046","authenticated-orcid":false,"given":"Matteo","family":"Megna","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery University of Naples Federico II  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[{"name":"Clinical Dermatology I.R.C.C.S. Istituto Ortopedico Galeazzi  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1777-9001","authenticated-orcid":false,"given":"Paolo","family":"Gisondi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Dermatology and Venereology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Argenziano","sequence":"additional","affiliation":[{"name":"Dermatology Unit University of Campania L. Vanvitelli  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketty","family":"Peris","sequence":"additional","affiliation":[{"name":"Institute of Dermatology, Universit\u00e0 Cattolica\u2010Fondazione Policlinico Universitario A. Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Prignano","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4381-6718","authenticated-orcid":false,"given":"Martina","family":"Burlando","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Health Sciences (DISSAL) IRCCS San Martino University Hospital  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Conti","sequence":"additional","affiliation":[{"name":"Dermatologic Unit, Department of Surgery Infermi Hospital, AUSL Romagna  Rimini Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Loconsole","sequence":"additional","affiliation":[{"name":"Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe\u2010J) University of Bari \u201cAldo Moro\u201d  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Malagoli","sequence":"additional","affiliation":[{"name":"Department of Dermatology Dermatology Unit Azienda Ospedaliera San Donato Milanese  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Zalaudek","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology Dermatology Clinic, Maggiore Hospital, University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Cacciapuoti","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery University of Naples Federico II  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6163-6921","authenticated-orcid":false,"given":"Francesco","family":"Bellinato","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Dermatology and Venereology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5485-0172","authenticated-orcid":false,"given":"Anna","family":"Balato","sequence":"additional","affiliation":[{"name":"Dermatology Unit University of Campania L. 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