Switching biologics in psoriasis - practical guidance and evidence to support

ABSTRACT

Introduction

Advances of biologic agents have changed the treatment paradigm of psoriasis to higher efficacy and better quality of life. However, the demand for biologic switch is increasing due to patient’s greater expectation and decreasing efficacy in long-term use. Also, biologic-induced adverse effects necessitate the switching of biologics.

Areas covered

This review article was divided into two parts. The first part focused on the biologic switch due to lack of efficacy. The second part provided switching suggestions related to adverse effects.

Expert commentary

Biologic switch in psoriasis was mainly due to lack of efficacy, and the subsequent biologic agent was usually given at the next scheduled time point without washout period. In pivotal randomized controlled trials, patients with poor response to TNF-alpha inhibitors and ustekinumab achieved better efficacy after switching to IL-23 and IL-17 inhibitors. In addition, real-world data showed that intra-class switch could still achieve a 50%-80% of PASI 75 response in individuals with anti-IL-17 failure histories. As for the biologic switch due to adverse effects, washout period was recommended and transition to a biologic agent with different modes of action was preferred, especially class-specific adverse events.

KEYWORDS:

• Biologic
• Il-12
• Il-23
• Il-17
• inadequate response
• psoriasis
• switch
• TNF-alpha

Declaration of interest

T.F. Tsai has conducted clinical trials or received honoraria for serving as a consultant for AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, EliLilly, Galderma, GSK-Stiefel, Janssen-Cilag, Leo-Pharma, Merck, Novartis, Pfizer, and Serono International SA (now Merck Serono International). Y.C. Tsai has delivered speeches held by AbbVie, EliLilly, Janssen-Cilag, Leo-Pharma, Novartis, Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Washout period is recommended when switching to another biologic agent due to side effects. On the contrary, washout period is not needed when the switch is due to lack of efficacy.

• Patients with history of biologic failure showed poorer response compared to those without failure history.

• In the consideration of efficacy, switching to the same class of biologic agents is still effective, which had shown in IL-17 inhibitors. However, for the switch due to side effects, transitioning to a different target molecule is suggested.

Additional information

Funding

This paper was not funded.