Examining Psoriasis Outcomes After Intraclass Switching of Interleukin-17 Antagonists

plaque psoriasis
plaque psoriasis
In some patients with plaque psoriasis, an intraclass switch from one IL-17 antagonist to another may be an effective treatment option.

For some patients with moderate-to-severe psoriasis who did not experience improvements with an interleukin (IL)-17 antagonist, an intra-class switch to a different IL-17 antagonist led to successful outcomes, according to a study published in the Archives of Dermatological Research.

Researchers retrospectively evaluated the success rate of switching patients with from an ineffective IL-17 antagonist treatment to a different IL-17 antagonist. Included patients had plaque psoriasis, a Psoriasis Area and Severity Index (PASI) score of at least 10 at baseline, and were non-responsive to their first IL-17 antagonist and switched to another IL-17 antagonist. PASI scores were evaluated at baseline and again at week 12.

Of the 26 patients included, 13 were men and 10 had a family history of psoriasis; the mean age was 53 years old, and the mean PASI score at baseline was 15.2. Overall, there were 29 intra-class switches; 15 of these patients reached a PASI score of 75. When secukinumab was switched to ixekizumab (n=18), 50% of the patients reached a PASI score of 75; 22% reached a PASI score of 50. When secukinumab was switched to brodalumab (n=7), 57% and 14% of patients reached a PASI score of 75 and 50, respectively. Limitations of this study include its retrospective design, a small sample size, and the subjectivity of the Psoriasis Area and Severity Index assessment.

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The researchers concluded that “[w]hen patients fail to respond or do not tolerate an IL-17 blocker, switching to another anti-IL-17A/RA is a promising viable option. Larger studies are needed to confirm our results.”

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Gasslitter I, Kirsten N, Augustin M, et al. Successful intra-class switching among IL-17 antagonists: a multicentre, multinational, retrospective study [published online March 16, 2019]. Arch Dermatol Res. doi: 10.1007/s00403-019-01907-y