title: Observational case series on a group of psoriasis patients who failed to respond to any TNF blockers.
abstract: BACKGROUND
  Data that can identify the patients who will not respond to anti-TNF agents are sparse. Therefore, the authors wished to describe specific clinical factors that could be associated with a non-response to any available TNF blockers in patients with psoriasis.
  
  
  METHODS
  A retrospective observational study was performed through the mailing of a questionnaire to five departments of Dermatology. Only psoriasis patients who were not responsive to all available anti-TNF agents (etanercept, infliximab and adalimumab), whatever the chronology of their use, were included.
  
  
  RESULTS
  Twenty-two patients were included. Forty patients (64%) did not work at the time of the study and 12 (55%) qualified for Social Security Disability Allowance. Forty patients (64%) were considered as "overweight". Fifty-nine percent of patients were smokers. Antinuclear antibodies were positive in 9 out of 16 patients tested (56%) at the time of non-response. Ustekinumab, which was further introduced in 19 patients, led to PASI 75 in all (94%) but one patient.
  
  
  CONCLUSIONS
  The data identified different clinical factors associated with a non-response to any available TNF blockers. Furthermore, non-responder patients were highly responsive to ustekinumab suggesting that in few psoriasis patients, TNF blockade is not the best target and other TNF-independent signaling pathway should be considered.
authors.affiliation: Sorbonne Paris-Cité Université, Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Dermatologie , Paris , France.
authors.forename: Manuelle
authors.initials: M
authors.lastname: Viguier
authors.forename: Cristina
authors.initials: C
authors.lastname: Livideanu
authors.forename: Marie
authors.initials: M
authors.lastname: Beylot-Barry
authors.forename: Marie-Aleth
authors.initials: MA
authors.lastname: Richard
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
authors.forename: Hervé
authors.initials: H
authors.lastname: Bachelez
authors.forename: François
authors.initials: F
authors.lastname: Aubin
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept