📊 Psoriasis Biologic Selection by PASI Response Simulator

Baseline PASI Scoring Before Biologic Selection

PASI captures erythema, induration, and scaling severity across body regions.

• 0–72: PASI scale range (higher means worse disease)
• PASI ≥10: Moderate-severe cutoff (typical biologic eligibility)
• >10%: BSA threshold (body surface affected)
• High: DLQI impact (quality-of-life burden)

Why baseline severity matters

Higher baseline PASI slightly lowers full-clearance odds across classes.

TNF Inhibitor Expected PASI Response

TNF blockers were the first widely used biologic class for psoriasis.

• 3: Class examples (adalimumab, etanercept, infliximab)
• ~60%: Typical PASI75 (at baseline PASI ~20)
• ~18%: Typical PASI100 (complete clearance rarer)
• 4–8 wk: Onset of effect (moderate speed)

TNF class positioning

Often first-line for joint involvement alongside skin disease.

IL-17 and IL-23 Inhibitor Expected Response

Newer cytokine-targeted biologics show higher skin clearance rates.

• ~70%: IL-17 PASI90 (secukinumab/ixekizumab-class)
• ~76%: IL-23 PASI90 (guselkumab/risankizumab-class)
• Quarterly: IL-23 dosing (lower injection burden)
• Fast: IL-17 onset (rapid early response)

Mechanism-driven gains

IL-17/IL-23 blockade yields higher PASI90/100 than TNF or IL-12/23.

Comparative PASI75/90/100 Achievement Across Classes

Side-by-side bars show relative clearance odds for each biologic class.

• IL-23: Best PASI75 class (highest overall response)
• IL-23: Best PASI100 class (most complete clearances)
• TNF: Lowest tier (still effective, lower ceiling)
• IL-12/23: Middle tier (moderate response profile)

Reading the comparison

Segments stack PASI75 → PASI90 → PASI100 per class.

Recommended Class Given Patient Inputs

Combining baseline severity and class efficacy suggests a starting choice.

• PASI90: Decision driver (primary ranking metric)
• Baseline PASI: Adjustment factor (reduces expected response)
• IL-23 class: Typical top pick (in most baseline scenarios)
• Required: Shared decision (patient preference matters too)

Using this tool

Simulator output is illustrative, not a clinical prescribing guide.

This is a decision-support illustration, not medical advice.