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Clinical Summary

Psoriasis: efficacy and tolerability of switching between biologic agents

Takeaway

  • Concomitant psoriatic arthritis and treatments, high initial Psoriasis Area and Severity Index (PASI) and nail involvement were the predictors of treatment discontinuation.
  • Patients who switched to a different biologic agent had similar improvement in PASI scores compared with biologic-naive patients.
  • Switching from the first biologic agent to the second because of inefficacy or adverse events may improve psoriasis.

Why this matters

  • According to the 2017 British Association of Dermatologists guideline, the washout period, co-morbidities, the pharmacology of the drugs and the patient’s opinion on the pros and cons of switching should be considered in case of switch to a second-line biologic.
  • However, the guideline did not recommend a specific order of biologics after the failure of the first-line biologic agent.

Study design

  • Retrospective study including 427 patients with psoriasis (with or without arthritis) who were treated with biologic agents.
  • Clinical efficacy of the initial and other biologic agents Revaluated using the PASI scores recorded at baseline and 12 weeks.
  • Funding: None disclosed.

Key results

  • Of 427 patients with psoriasis, 145 (34%) switched to another biologic agent.
  • At 12 weeks, PASI score reduced by 67.7% and 51.4% in patients treated with the first- and second-line biologic agents, respectively.
  • In drug survival analysis:
    • no significant difference was observed between the drug survival of the first-line biologic agents (log-rank P=.117).
    • ustekinumab had the highest survival rate vs other second-line therapies (log-rank P=.010).
  • In multivariate analyses for overall drug discontinuation, concomitant psoriatic arthritis (OR, 1.883; 95% CI, 1.274-2.782; P=.001) and treatment (OR, 2.303; 95% CI, 1.403-3.780; P=.001) and nail involvement (OR, 2.334; 95% CI, 1.534-3.552; P<.001) were the predictors of discontinuation.
  • No significant differences were observed in PASI scores in patients treated with adalimumab (OR, 1.053; 95% CI, 1.013-1.093; P=.008) and ustekinumab (OR, 1.103; 95% CI, 1.020-1.193; P=.014) between switched and non-switched groups.

Limitations

  • Retrospective design.

References


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