Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Abstract

<b><i>Background/Objective:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>n</i> = 106, 62.4%), adverse events (<i>n</i> = 28, 16.5%), and others (<i>n</i> = 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 <i>p</i> = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274–2.782, <i>p</i> = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534–3.552, <i>p</i> &#x3c; 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 –3.780, <i>p</i> = 0.001) are predictors for discontinuation. <b><i>Conclusion:</i></b> 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.