Switching infliximab in psoriatic patients during COVID ‐19 pandemics: A real‐life retrospective study comparing intra‐versus interclass switching strategies

Abstract

During this pandemic, dermatological infusion centers were partially unavailable, suspended or even reconverted to guest COVID‐19 patients, consequently infliximab (IFX) infusions became challenging for their both logistic arrangement and also for patients' COVID‐19 phobia. This 48 weeks follow‐up retrospective observational study included 37 PsO patients that underwent IFX SB2 during pandemic in two primary dermatological referral centers. In 23 (62.1%) we had to switch from IFX to other biologics, not motivated by adverse reactions, contraindication or even loss of response but only to pandemic related conditions. Nine patients underwent interclass switching and 15 underwent intraclass switching; interestingly 2 patients that underwent adalimumab SB‐5 switched back to IFX. Interclass switching was privileged in elder patients and smokers. All patients at week 48 achieved PASI 100. Intra‐ and interclass switchings are both safe and effective strategies in psoriatic patients with COVID‐19 phobia and/or difficulties to undergo infliximab infusions.

Secukinumab Loss of Efficacy Is Perfectly Counteracted by the Introduction of Combination Therapy (Rescue Therapy): Data from a Multicenter Real-Life Study in a Cohort of Italian Psoriatic Patients That Avoided Secukinumab Switching

“…These options enrich the dermatological armamentarium to treat plaque psoriasis, but actually, beside the PASI75 failure at week 16 and drug-related major adverse events, no clear switching criteria are validated, making study comparison very challenging, since switching criteria are usually not even reported. In Italy, that has a universalistic healthcare system, we recently experienced three type of biologic switching: clinically driven (loss of function of the previous drug), pharmaco-economic driven (only from originator to biosimilar or from biosimilar to biosimilar) and COVID-19 pandemic driven (to drugs that deserves less administration per year to avoid hospitals) [21]. Furthermore, comparing universalistic (i.e., Italy) and non-universalistic healthcare systems (i.e., US), two main differences in switching appear: in non-universalistic systems the switching may be performed also in case of insurance changes and the use of biosimilar is extremely rare.…”

“…Due to the chronic nature of psoriasis [1][2][3], the affected patients may experience several comorbidities (i.e., respiratory [4][5][6][7][8], cardiovascular [9][10][11][12][13] or gastrointestinal ones [14][15][16][17]) and therapy failures [18][19][20][21][22][23][24][25]. Thus, therapeutic strategies play a pivotal in limiting the psoriasis detrimental progression and the quality of life worsening.…”

“…Nowadays, several anti-psoriatic systemic therapies are marketed, but, at the same time, also multi-failure (>2 biologics failed) patients are not rare [21]. Due to this intricated scenario, the rationale for switching, instead using a combined therapy, is a matter of debate.…”

“…Due to this intricated scenario, the rationale for switching, instead using a combined therapy, is a matter of debate. To date, different reasons (i.e., pharmaco-economically (originator to biosimilar [33]), insurance [34], COVID-19 pandemic [21]) lead to several drug switchings in a single patient. Interestingly, data toward combination therapies in psoriatic patients remained scarce [35][36][37][38], so we performed a retrospective observational study including all patients treated secukinumab, who underwent a secondary loss of efficacy and started another concomitant systemic (rescue therapy) treatment to avoid the switching to other biologics.…”

Artesunate, imatinib, and infliximab in COVID‐19: A rapid review and meta‐analysis of current evidence

“…The findings of one study found no benefit for using infliximab in COVID‐19 patients in terms of the length of hospital stay. 74 According to the findings of meta‐analysis, patients taking infliximab showed earlier hospital discharge compared with the control group. Nonetheless, infliximab showed no benefit in terms of mortality rate.…”