Korean J Dermatol.  2022 Aug;60(7):420-428.

Analysis of the Switching Patterns of Biologics and Their Efficacy after Switching in Moderate-to-Severe Psoriasis Patients

• Lee SM
• Ko BC
• Ahn SW
• Uh JA
• Seol JE
• Kim H
• Lee SK
• Kim MS
• Lee UH
• Park SH
• Jung SY
• Park HJ

Abstract

Background
Biologics-experienced patients are more likely to show a lower response to biologics than that of biologic-naïve patients. However, no consensus on switching biologics exists.
Objective
We aimed to investigate the switching patterns and efficacy of the switched biologics in patients with moderate-to-severe psoriasis in actual clinical practice.
Methods
This multicenter retrospective study included 37 patients with a history of switching biologics. We analyzed the reasons for switching, the switching patterns, and psoriasis area and severity index (PASI) 75 response rates after switching biologics. We also analyzed the factors affecting the PASI75 response rate to the second biologic.
Results
The reasons for switching baseline biologics were primary failure in five patients (13.5%), secondary failure in 28 patients (75.7%), and adverse events in four patients (10.8%). The second biologics prescribed mostly include interleukin (IL)-23 inhibitor in twenty-four patients (64.9%), IL-17 inhibitor in eight patients (21.6%), tumor necrosis factor-α inhibitor in three patients (8.1%), and IL-12/23 inhibitor in two patients (5.4%). A total of 46% of patients (17/37) switched biologics from IL-12/23 inhibitors to IL-23 inhibitors. The PASI75 response rates at the primary endpoint of the second and third biologics were 89.2% and 88.8%, respectively. Our study found that female sex and obesity were associated with the primary failure of the second biologic.
Conclusion
Secondary failure was the most common reason for switching baseline biologics. Korean dermatologists prefer different classes of biologics while switching. The PASI75 response rates at the primary endpoints of the second and third biologics were relatively satisfactory.

Keyword

Biological products; Psoriasis; Switching