Switching biologics for psoriasis over time.

[Fred]

This study looked at switches between biologics and how their pattern changed over time with the recent availability of new biologic agents.

Quote:

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Background:
Biologics are the cornerstone of treatment of patients with moderate-to-severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time.

Objectives:
The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents.

Methods:
We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate-to-severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra-class – i.e. within the same therapeutic class - versus inter-class) in patients switching from a TNF-alpha inhibitor using multivariate logistic regression.

Results:
A total of 2,153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF-alpha inhibitor before 2016 mostly switched to ustekinumab whereas those switching in 2016 or after mostly switched to an IL-17 inhibitor. Patients switching from a first line TNF-alpha inhibitor before 2016 were more likely to switch to another TNF-alpha inhibitor compared to patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF-alpha inhibitor rather than another therapeutic class of bDMARD compared to patients switching from adalimumab.

Conclusion:
This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL-17 inhibitors.

Source: onlinelibrary.wiley.com

*Early view funding unknown. 

Biological Treatments For Psoriasis

[Caroline]

Not really clear to me what this means.

I seem to read that after a while most TNF-alpha medication is stopping to work. In favor of IL-xx , is that a correct conclusion.

[Fred]

Not really clear to me what this means.

I seem to read that after a while most TNF-alpha medication is stopping to work. In favor of IL-xx , is that a correct conclusion.

For me yes the IL are better than the TNF, but I can't use TNF anyway since having reactions to them.

[D Foster]

Mmmmm

[KatT]

Well I went from TNF, to IL to another IL and now back to TNF

Every one is different and regardless of the type, the all seem to fail at some point 

[mataribot]

I think the problem with biologics for Ps is the lack of weight base dose. Other diseases being treated with biologics have variable doses.

[Fred]

I think the problem with biologics for Ps is the lack of weight base dose. Other diseases being treated with biologics have variable doses.

I tried all sorts of variables with Stelara but it didn't really help, and at the moment I've started straight away on a double dose of Ilumetri.

Still yet to find one that I think will be the one.