OBJECTIVES:  We evaluated the effectiveness of biologics in achieving skin improvements for patients with psoriasis. METHODS: Interim analyses of an ongoing, biennial, 12-month observational cohort of 857 patients with moderate to severe plaque psoriasis initiating or switching biologics between March 2014–March 2016 (France=237, Italy=182, United Kingdom=95, Germany=67, United States=276) were conducted. We assessed skin improvement via 100%/90%/75% decreases in Psoriasis Area and Severity Index (PASI); HRQOL disability by Dermatology Life Quality Index (DLQI; range 0­–30; 0=no impairment); and Psoriasis Symptom Inventory (PSI; range 0­–32; 0=not at all severe). RESULTS:  Demographics/baseline clinical characteristics were 62.8% male; age 47.4 (13.8) years; psoriasis duration 18.2 (13.1) years; and PASI 14.3 (9.3) (mean [standard deviation]). At baseline, 59.9% had initiated their first biologic, and 39.4% had switched biologics. 572 and 276 patients had 6- and 12-month assessments. At 6 months, PASI100 was achieved by 21.9% of the total cohort (95% CI: 18.5–25.5), 21.6% in Europe (17.7–26.0), and 22.3% in the US (16.5–29.2). At 6 months, PASI90 was achieved by 34.4% (30.5–38.5), 35.9% in Europe (31.1–40.8), and 31.3% in the US (24.6–38.6), while PASI75 was achieved by 52.1% (47.9–56.3), 55.5% in Europe (50.4–60.5), and 44.7% in the US (37.3–52.3). At 12 months, PASI100 and PASI90 responses were achieved by 26.1% (21.0–31.7) and 45.3% (39.3–51.4) of the total. Only 31.4% (27.6–35.5) at 6 months and 37.2% (31.5–43.2) at 12 months achieved DLQI=0 (no impairment). Moreover, only 22.7% (19.3–26.4%) and 27.7% (22.5–33.4) reported non-severe symptoms (PSI=0) at 6 and 12 months (similar findings for Europe and US). CONCLUSIONS: The majority of patients did not achieve PASI100 and PASI90 through 12 months, indicating unmet need despite available biologic treatments. This burden is further reflected by impairment associated with dermatologic symptoms.