Switching Therapeutic Class in Psoriasis Linked to Better Treatment Efficacy

The investigators sought to describe switching patterns in dermatologic real-life daily practice among patients with psoriasis.

Among patients with psoriasis who require a switch in treatment, a change of therapeutic class appears to be more effective than a switch to an agent in the same therapeutic class, according to the results of a noninterventional, retrospective, multicenter analysis conducted at 11 volunteer dermatology centers in France. Findings from the study were published in Dermatologic Therapy.

The investigators sought to describe switching patterns in dermatologic real-life daily practice among patients with psoriasis. Efficacy was defined as achievement of ≥75% improvement in Psoriasis Area and Severity Index (PASI 75) score, which was evaluated between 12 and 16 weeks after initiation of a new therapy. Patients enrolled in the study included those who were seen in routine daily practice and were being treated with infliximab, etanercept, adalimumab, or ustekinumab. A standardized case report form was filled out for each participant, which included the patient’s characteristics and clinical details, including all prior treatments.

A total of 1157 patients were included in the study, of whom 29.9% (346 of 1157) required a switch in treatment. The mean duration of treatment before the switch was 529.2 days for ustekinumab (range, 121-978 days), 450 days for etanercept (range, 13-2100 days), 431 days for adalimumab (range, 26-1729 days), and 424.2 days for infliximab (range, 4-1977 days; P =.21). When the first-line biologic agent was administered concomitantly with methotrexate, the mean duration of treatment was 530 days (range, 4-2100 days) compared with 439 days (range, 54-1638 days) when the biologic was administered as monotherapy (P =.14).

Switch in biologic agent, which was attributed to lack of efficacy, loss of therapeutic response, or adverse events, was considered effective in 71.9% of patients and ineffective in 28.1% of patients. Notably, switch efficacy was not known for 18 patients because of relocation or missing data.

The results provide a clearer understanding of the profile of patients with psoriasis who require a switch in their therapy, as patients were mostly men, were approximately 40 years of age on initiation of their first biologic agent, and were overweight (mean body mass index, 28 kg/m2). In addition, almost half of all individuals who switched had confirmed psoriatic arthritis.

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The investigators concluded that the findings from this study are reflective of the high rate of comorbidities among patients with psoriasis and emphasize the role played by dermatologists in screening comorbidities among patients with psoriasis who require systemic therapy. This role is even more critical in the subpopulation of patients who require a switch from their first-line biologic therapy, regardless of the reason.

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Dabouz F, Khemis A, Barbe C, et al; Resopso network. Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real-life practice: the Resoswitch study [published online November 28, 2018]. Dermatol Ther. doi: 10.1111/dth.12789