7 August 2024
Why do psoriasis patients switch biologics?
Australian researchers followed a cohort for 14 years to get some answers. Here’s what they found.
Biologic-switching is a common practice in patients with moderate to severe psoriasis, Australian researchers have found.
They also found a favourable uptake of the new IL-17 and IL-23 inhibitors, with the former shown to have a more rapid onset of action than the other biologics, with excellent skin clearance.
The paper, published last month in the Australasian Journal of Dermatology, detailed the results of a retrospective study of patients who attended outpatient dermatology biologic clinics across two tertiary hospitals in Sydney.
The study took place across RPA and Westmead hospitals and examined biologic treatment sequencing in adults with moderate, severe psoriasis for a 14-year period from 2006 to 2020. Specifically, the researchers examined 263 patients, who underwent a total of 438 treatment courses.
Lead author, Dr Samantha Ting, from Sydney University and the Sydney Local Health District Dermatology Research Team, told Dermatology Republic that it was a valuable project.
“At present, with the introduction of so many new biologics, we are still gathering a lot of real-world evidence on the efficacy and the tolerability of biologics and psoriasis, but very few studies have actually examined biologic switching patterns,” she said.
“One of the key findings here was that, yes, the most common reasons for biologic switching was related to either lack or loss of efficacy, but an absolute PASI 3 was generally the threshold that prompted most patients to switch therapies.
“This could therefore be considered a cut-off for patients when determining their treatment goals, which I thought was quite a useful finding.”
Rapid skin clearance was also often cited by patients as an important treatment goal, the researchers wrote. In addition, patients who switched biologics often had higher rates of psoriatic arthritis and higher BMI, factors that influenced the choice of subsequent therapies. The presence of psoriatic arthritis particularly influenced the shift towards IL-17 inhibitors.
“Patients and clinicians often have incongruent views of treatment goals, leading to patient dissatisfaction and poor treatment adherence,” they wrote.
“Low absolute PASI is a better outcome for patients than PASI-75 or PASI-90. Thus, this study’s data can inform decisions about biologic-switching in keeping with patients’ treatment goals.
“This study also serves as a source of preliminary information for further larger-scale studies in the future, which will shape clinical guidelines on treatment sequencing.”
Among the other key findings were trends in biologic usage.
When it came to first-line treatments, ustekinumab and adalimumab were the most frequently prescribed first-line biologics. However, following the introduction of secukinumab in 2015, there was a notable shift towards the use of IL-17 inhibitors and ustekinumab for biologic-naïve patients.
For second and third-line treatments, post-2015, IL-17 inhibitors became the most common choice, reflecting a trend towards newer therapies with potentially better efficacy and safety profiles.
Dr Ting told DR the study made an important contribution to understanding biologic sequencing for psoriasis treatment in Australia, and underscored the significance of achieving low PASI scores.
It also highlighted the need for more research with larger sample sizes and comprehensive data on all available biologics to help shape clinical guidelines and optimise psoriasis treatment approaches.
