Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Abstract

Background/Objective: The purpose of our study was to provide evidence on the treatment choices, reasons, and results of switching between biologic agents in treating patients with psoriasis. Methods: We conducted a retrospective database search of six tertiary referral centers for pso­riasis patients between January 2007 and May 2019. We analyzed patient and treatment characteristics of all patients in the registry. Results: We enrolled 427 psoriatic patients treated with biologics, and 145 (34%) required a switch to another biologic. The reasons for discontinuing the first biologic agent were inefficacy (n = 106, 62.4%), adverse events (n = 28, 16.5%), and others (n = 36, 21.2%). At week 12, there was a 67.7% reduction in the Psoriasis Area and Severity Index (PASI) score of patients treated with their first biologic, and 51.4% reduction for the second. A drug survival analysis showed no statistically significant difference between the drug survival of first-line biologic agents, but ustekinumab had the highest survival rate among second-line biologics (log-rank p = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274–2.782, p = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534–3.552, p < 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 –3.780, p = 0.001) are predictors for discontinuation. Conclusion: Discontinuation of treatment was most commonly due to inefficacy. Patients who switched to a different biologic agent showed a similar improvement in PASI scores compared to biologic-naive patients. Switching to a second biologic therapy due to inefficacy or adverse events caused by the first one may improve psoriasis.

Real‐world, long‐term treatment patterns of commonly used biologics in Canadian patients with moderate‐to‐severe chronic plaque psoriasis

“…In clinical practice, modifications of dosing regimens, 9–13 intermittent therapy, or interruption followed by retreatment 14,15 have been reported to impact treatment effectiveness. Biologic switches in the treatment of PsO have been evidenced to be mostly due to a lack of efficacy, to adverse events (AE) to a lesser extent, or to efforts to achieve better clinical response 6,10,15–19 . Specific to Canadian real‐world practices, off‐label regimens are less likely to include biologics dose reductions or interval increases compared with other practices worldwide such as European practices 11 …”

Retrospective analysis of patients with psoriasis receiving biological therapy: Real‐life data

“…16 Although the scientific basis is not clear yet, switching from one anti-TNF agent to another may be an effective therapeutic option. 17 The efficacy of biological treatments in psoriasis has been shown in numerous clinical trials. However, these results may not always be compatible with real-life data.…”

“…A randomized, double‐blinded, placebo‐controlled, 16‐week study of 282 patients showed that switching from another anti‐TNF agent to adalimumab resulted in a significant improvement in PASI scores 16 . Although the scientific basis is not clear yet, switching from one anti‐TNF agent to another may be an effective therapeutic option 17 …”

Psoriasis in areas difficult to treat and biological therapy

“…Clinical improvement (reduction of PASI and BSA) after biological treatment in psoriasis with nail involvement may be slower than in psoriasis with no nail involvement. A drug switch is also required more frequently [29][30][31]. Nevertheless, biological drugs seem to be more effective than classic drugs.…”

“…Poprawa kliniczna (redukcja PASI i BSA) po leczeniu biologicznym w łuszczycy z zajęciem paznokci może być wolniejsza niż w łuszczycy bez zajęcia płytek paznokciowych. Częściej wymagana jest również zmiana leku [29][30][31]. Leki biologiczne wydają się jednak skuteczniejsze niż leki klasyczne.…”