Korean J Dermatol.  2021 Nov;59(9):707-712.

Clinical Features and Treatment Considerations When Switching Biologics in Korean Patients with Severe Psoriasis: A Retrospective Single-Centered Study

• Kim TH
• Kim DC
• Lee ES

Abstract

Background
Since the advent of biologics, they have been an efficient treatment for severe psoriasis vulgaris. Psoriasis that is refractory to biologics is associated with factors, such as old age, a high initial psoriasis area and severity index, a high body mass index (BMI), and nail involvement.
Objective
We evaluated the clinical characteristics and differences in laboratory parameters in patients with severe psoriasis who switched biologics at least once.
Methods
We analyzed the demographics, medical records, and laboratory data of 29 Korean patients who had switched biologics. Patients were classified into two groups based on the number of times they switched to biologics.
Results
The reasons for switching biologics in the 29 patients were primary failure (37.9%), secondary failure (58.6%), and occurrence of adverse events (3.5%). The multiple switching group showed higher mean values than the single switching group for the factors associated with low efficacy of biologics, such as age at initial presentation (43.4±9.6 years vs. 42.1±12.1 years), an initial psoriasis area severity index (15.3±6.3 vs. 12.9±4.4), and a BMI (27.4±4.0 kg/m² and 26.3±3.4 kg/m² ), respectively.
Conclusion
In this single-centered study, secondary failure was the most common reason for switching biologics. Higher mean values for factors affecting the efficacy of biologics were noted in the multiple switching group; however, the difference was not statistically significant. When choosing biologics for patients, dermatologists should be mindful of this as they select the second-line biologics.

Keyword

Biologics; Guselkumab; Ixekizumab; Psoriasis; Secukinumab; Ustekinumab