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.