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Background
Switching therapies is common for patients with psoriasis.
Objective
To quantify real-world switching rates and characteristics among patients initiating biologics over 24 months.
Methods
Patients aged ≥18 years with ≥2 confirmed psoriasis diagnoses who initiated a new biologic were identified from a US-payer claims database (Merative®...
Citations
... to their older approval [14]. However, the latter have higher switching rates compared to the other classes of inhibitors [5]. Although, antibodies against TNFα demonstrate an intra-class variation in response, thus allowing for an effective switch from etanercept to adalimumab for example [15], newer-generation antibodies against IL-17 and IL-23, such as brodalumab and risankizumab, are more often prescribed as a 2nd treatment line [5]. ...
... However, the latter have higher switching rates compared to the other classes of inhibitors [5]. Although, antibodies against TNFα demonstrate an intra-class variation in response, thus allowing for an effective switch from etanercept to adalimumab for example [15], newer-generation antibodies against IL-17 and IL-23, such as brodalumab and risankizumab, are more often prescribed as a 2nd treatment line [5]. Lack of efficacy is the most common reason for switching treatments [14,16]. ...
... Although the factors affecting persistence of biologics in psoriasis have been thoroughly studied in retrospective reports accessing patient specific registries [7,12,13,17], it is not clear which factors may impact the switching patterns. Factors, such as the previous use of a targeted immune modulator (biologic or apremilast), increased age and female gender have been proposed to predict treatment switching [5]. Multiple comorbidities, such as psoriatic arthritis (PsA) [18], and simultaneous administration of non-biological treatments have been associated with treatment discontinuation and reduced persistence [19]. ...
Multiple parameters define the treatment course with biologics for a psoriatic patient while treatment switches are often associated with worse prognosis. The purpose of this study was to describe the switching patterns of biologics for psoriasis in the Greek market landscape and to detect associated factors that may impact the evolvement of selected therapy. This is a retrospective cohort study using data recorded in the nationwide digital prescription database of Greece. Patients with a diagnosis for psoriasis, with or without concomitant psoriatic arthritis (PsA), who had initiated a biologic treatment between January 1st 2016 and December 31st 2020 were included. Overall, 6,772 biologic-naïve patients were included. Patients treated with infliximab demonstrated the highest switching rates while those treated with ustekinumab and secukinumab the lowest. Secukinumab and brodalumab had the lowest rates of switch or re-initiation 12 months after initiation. Switches from secukinumab to brodalumab and ustekinumab and from adalimumab to secukinumab and ustekinumab were more frequently observed. The risk was significantly higher for patients with concurrent PsA and for women, while patients treated with brodalumab, secukinumab and ustekinumab demonstrated a lower risk compared to adalimumab. Antibodies against interleukins have lower switching rates compared to more traditional biologics. The time to switch is longer for the first transition highlighting the necessity to establish long term therapeutic options early in the treatment course. Concurrent PsA or gender may have a significant impact in outcome, thus they need to be considered before the launch of a selected therapy.
... Additionally, IL-23 inhibitor users exhibit the lowest rate of switching to other treatments, followed by users of IL-12/23 inhibitors, IL-17 inhibitors, and TNF inhibitors, indicating fewer Fig. 4 Risk of psoriatic arthritis associated with use of IL inhibitors, compared with use of TNF inhibitors, stratified by sex or age group. IL interleukin, IR incidence rate, TNF tumor necrosis factor, py person-years, CI confidence interval, PS propensity score issues with treatment effectiveness or tolerability [35][36][37]. Our findings also suggest that IL-23 inhibitors may offer the best results for the prevention of PsA, contributing to the growing body of evidence that could inform future updates to clinical guidelines for the treatment of psoriasis. ...
Evidence comparing the impact of various biologics for psoriasis on the progression to psoriatic arthritis (PsA) is limited. We therefore assessed the risk of PsA associated with interleukin (IL)-23 inhibitor, IL-17 inhibitor, or IL-12/23 inhibitor use compared with tumor necrosis factor (TNF) inhibitor use among patients with psoriasis.
This population-based cohort study used the nationwide claims database from South Korea (2007–2023). New users of IL or TNF inhibitors with psoriasis who did not have PsA or other inflammatory arthritis were categorized into each class of the IL inhibitors for comparison with TNF inhibitor users. The outcome measured was the development of incident PsA. We calculated multinomial overlap weights to balance predefined covariates. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.
We identified 9499 patients with psoriasis (mean age 45.1 years; 33.6% female), of whom 3913 (41.2%), 2126 (22.4%), 2773 (28.8%), and 727 (7.7%) were exposed to IL-23 inhibitor, IL-17 inhibitor, IL-12/23 inhibitor, and TNF inhibitor, respectively. PsA developed in 281 (3.0%) patients during 23,275 person-years. The weighted HR for any IL inhibitors was 0.40 (95% CI 0.25–0.62), with specific HRs of 0.22 (95% CI 0.13–0.37), 0.47 (95% CI 0.28–0.80), and 0.46 (95% CI 0.29–0.74) for IL-23 inhibitor, IL-17 inhibitor, and IL-12/23 inhibitor, respectively. IL-23 inhibitors exhibited the greatest rate difference of − 2.61 (95% CI − 3.67 to − 1.55) cases of PsA per 100 person-years.
The use of IL inhibitors, particularly IL-23 inhibitors, compared with TNF inhibitors, was associated with a lower risk of developing PsA.
... Additionally, drug response may diminish over time, resulting in clinical inertia and unaddressed treatment goals [10]. To address patient needs and goals, switching to another biologic treatment may benefit patients who do not respond well to their current treatment [11]. ...
... Recent studies have shown that switching within the same biologic class may be less beneficial than switching to another mode of action [11,36,37]. Two small real-world single-center studies evaluating the efficacy and safety of switching to risankizumab in patients who previously failed anti-IL 17 inhibitors found that switching to risankizumab was beneficial [38,39]. ...
... Two small real-world single-center studies evaluating the efficacy and safety of switching to risankizumab in patients who previously failed anti-IL 17 inhibitors found that switching to risankizumab was beneficial [38,39]. In addition, real-world data analyzing the differences between modes of action regarding switching demonstrated that IL-23 inhibitors, and especially risankizumab, were shown to have the lowest switch rates relative to all other biologics [11,40]. ...
Risankizumab has demonstrated superior efficacy compared to other psoriasis treatments, including secukinumab, adalimumab, and ustekinumab; switching to risankizumab from other psoriasis treatments has shown superior clinical and quality of life (QoL) outcomes. We evaluated the efficacy and safety of directly switching patients with moderate-to-severe plaque psoriasis and a suboptimal response to interleukin (IL)-17 inhibitors (secukinumab or ixekizumab) to risankizumab.
This 52-week, phase 3b study enrolled patients (≥ 18 years) with moderate-to-severe plaque psoriasis who had previously been treated with the recommended dose of secukinumab or ixekizumab for ≥ 6 months but did not achieve an optimal response (static Physician's Global Assessment [sPGA] 2/3; body surface are [BSA] 3– < 10%). Patients received subcutaneous risankizumab (150 mg) without washout. The primary endpoint was the proportion of patients achieving sPGA of 0/1 at week 16. Secondary endpoints included sPGA 0/1 at week 52, sPGA 0, Dermatology Life Quality Index (DLQI) 0/1, and Psoriasis Symptoms Scale (PSS) 0 at weeks 16 and 52. Safety was monitored throughout the study.
The study included 244 patients. sPGA 0/1 was achieved by 57.4% and 62.3% at week 16 and 52. At week 16, sPGA 0, DLQI 0/1, and PSS 0 were achieved by 20.5%, 40.2%, and 20.9%, respectively. At week 52, these proportions increased to 27.1% for sPGA 0, 47.2% for DLQI 0/1, and 27.5% for PSS 0. Most frequently reported adverse events (reported in ≥ 5% of patients) in risankizumab-treated patients were COVID-19 infection (8.6%) and nasopharyngitis (5.7%). No new safety signals were observed.
Directly switching to risankizumab improved outcomes and QoL in patients with moderate-to-severe psoriasis who had suboptimal responses to anti-IL-17 inhibitors (secukinumab or ixekizumab). The safety results are consistent with previously reported safety of risankizumab. This study supports the efficacy of risankizumab in patients previously treated with biologics, including IL-17 inhibitors, and suggests a direct switch to risankizumab for improved clinical outcomes and QoL.
ClinicalTrials.gov identifier: NCT04102007.
... Prior targeted immune modulator use, age, and female sex have been identified as predictors of treatment switch in patients with psoriasis using biologic therapy, 22 but few studies in plaque psoriasis or other chronic diseases have assessed the association between patient-reported outcomes, independently of clinician-assessed disease severity or patient demographics, in relation to treatment switching behavior. Research in plaque psoriasis and other chronic disease areas has, however, consistently found an association between HRQoL and healthcare resource utilization, [19][20][21] and between patientperceived treatment effectiveness and treatment adherence. ...
Purpose
This real-world study investigated the impact of patient-reported disease burden and health-related quality of life (HRQoL) on switching from systemic nonbiologic to biologic therapy in patients with plaque psoriasis.
Patients and Methods
Biologic therapy–naive (biologic-naive) patients aged ≥18 years who were using systemic nonbiologic treatment and who enrolled in the CorEvitas Psoriasis Registry between April 2015 and August 2022 were included. Measures of patient-reported disease burden and HRQoL were collected at Registry enrollment. The primary outcome of interest was initiation of biologic therapy within 45 days of enrollment. Multivariable logistic regression models were fitted separately for each patient-reported measure, adjusting for patient, disease, and treatment characteristics, including physician-rated disease severity. Adjusted odds ratios of switching to biologic therapy were estimated for greater versus lesser burden for each measure.
Results
Of 848 included patients, 323 (38.1%) switched to biologic treatment. Greater patient-reported burden was independently associated with switching, with significantly higher adjusted odds ratios (95% confidence interval) for greater versus lesser burden as measured by the Dermatology Life Quality Index (1.55 [1.08–2.23], P=0.017), visual analog scale (VAS) for itch (2.14 [1.49–3.08], P<0.001), VAS for skin pain (2.18 [1.45–3.29], P<0.001), VAS for fatigue (1.66 [1.15–2.40], P=0.007), Patient Global Assessment-VAS (3.09 [1.94–4.91], P<0.001), and with activities impairment on the Work Productivity and Activity Impairment questionnaire (2.51 [1.72–3.65], P<0.001).
Conclusion
In addition to clinically assessed disease severity, patient-reported disease burden and quality of life may drive the switch to biologic treatment in real-world patients with plaque psoriasis.
... proportion of young psoriasis patients [9]. Since biologic therapy has a systemic effect, one might expect it to also improve or even normalize metabolic disorders by reducing systemic inflammation. ...
Metabolic disorders are common in patients with psoriasis and contribute significantly to an increased cardiovascular risk. While biologic therapy is very successful in clearing skin lesions, its impact on metabolic parameters is uncertain. Our aim was to investigate the residual metabolic burden in psoriasis patients successfully treated with biologic therapy. We conducted a cross-sectional study of 80 young patients (54 men, 26 women, aged 30–45 years) successfully treated with either adalimumab, secukinumab or guselkumab and topical therapy or methotrexate, and 20 healthy controls. Anthropometric parameters, lipid levels and metabolic indices (HOMA-IR, TyG index and FIB-4 index) were measured. Patients did not receive any other treatments to exclude confounding effects. After analysis, we found that patients treated with three different biologics had similar metabolic status, only the FIB-4 index was higher in the adalimumab group than in the secukinumab and guselkumab treatment groups. There were no significant differences between the patients treated with biologics and the control group. The comparison with patients treated topically or with methotrexate showed that only triglyceride levels, HOMA-IR, TyG index, and FIB-4 index were elevated in patients treated with adalimumab compared to patients treated with topical therapy. Finally, metabolic status was also similar in patients treated with methotrexate or topical therapy. In conclusion, this study suggests that psoriasis patients successfully treated with biologics have similar metabolic parameters to the control group and patients treated with topical therapy or methotrexate. This indicates that there is no significant residual metabolic burden in young patients successfully treated with biologics. These results are clinically relevant and should be considered in the treatment of psoriasis patients.
The study is registered at http://clinicaltrials.gov (identifier: NCT05957120). Date of registration: 24th of July 2023.
... Several effective systemic biologic therapies are available to treat PSO and PsA, but patients may often switch systemic biologic therapies over the course of treatment because of heterogeneity across symptom profiles and individual responses to treatment [2,[6][7][8][9][10][11]. Estimates from claims-based studies suggest that approximately 20% of patients with PSO and approximately 20% of patients with PsA switch treatments within 1 year of biologic initiation [12,13]. ...
... Several effective systemic biologic therapies are available to treat PSO and PsA, but patients may often switch systemic biologic therapies over the course of treatment because of heterogeneity across symptom profiles and individual responses to treatment [2,[6][7][8][9][10][11]. Estimates from claims-based studies suggest that approximately 20% of patients with PSO and approximately 20% of patients with PsA switch treatments within 1 year of biologic initiation [12,13]. For some patients, therapy switches may lead to poorer outcomes and increased healthcare costs [6,10,11,14]. The relationship between health-related QoL (HRQoL) and disease severity measures as drivers of biologic therapy switching among patients with PSO or PsA is unclear [9,15,16]. ...
... The study results are generalizable to adult patients with PSO and concomitant PsA encountered in typical clinical practice in the US and Canada who have been treated with a systemic biologic therapy for up to 30 months. An additional strength was the degree to which reasons for switching were captured in this analysis, since documented reasons are often limited or missing in reports evaluating biologic switching patterns among PSO and patients with PsA [10,12,36]. Finally, the total number of patients excluded for missing covariate information at baseline or PASI/DLQI at follow-up was small (< 5%) as the study measures were defined to minimize or account for missing data, and any effects of bias were expected to be minimal because of the completeness of the registry data. ...
Patients with psoriasis (PSO) and psoriatic arthritis (PsA) may frequently switch biologic therapies over the course of treatment because of symptom variability and individual responses. Real-world studies analyzing patient characteristics and clinical factors associated with biologic switching are limited.
This longitudinal cohort study used real-world data from the CorEvitas Psoriasis Registry to evaluate the relationship between associated disease factors and biologic switching among patients with PSO and PsA in the United States (US) and Canada following initiation of a biologic. Patients were evaluated between April 2015–August 2022. Combinations of disease severity (as measured by Psoriasis Area Severity Index [PASI]) and Dermatology Life Quality Index (DLQI) as a measure of health-related quality of life (HRQoL) were assessed, and the association with time to switching was calculated using Cox proportional hazards regression modeling.
Among 2580 patient-initiations (instances of patients initiating a biologic), 504 (19.5%) switched biologics within 30 months of initiation. Switching was more frequent when either PASI > 10 or DLQI > 5 compared with PASI ≤ 10 or DLQI ≤ 5 at follow-up. Patients with higher skin involvement (PASI > 10) and impact on HRQoL (DLQI > 5) were 14 times more likely to switch (hazard ratio = 14.2, 95% confidence interval: 10.7, 18.9) than those with lower skin involvement (PASI ≤ 10) and HRQoL (DLQI ≤ 5).
Patients with PSO and PsA treated in a real-world dermatology setting with substantial disease factors following biologic initiation were more likely to switch therapies. Those with PASI > 10 and DLQI > 5 switched more frequently than those with PASI ≤ 10 and DLQI ≤ 5.
... Moreover, the study by Armstrong et al. found that among 7,997 patients, treatment switching rates were 14.4% and 26% at 12 and 24 months, respectively. In addition, IL-23 inhibitors were associated with the lowest risk of switching compared with TNF, IL-17, and IL-12/23 inhibitors over 24 months (p < 0.001) (13). ...
... Etanercept had the lowest survival rate at 1 year (57.7% ) and at 5 years (30.3% ) (29). Additionally, real-world data from the united States (uS) confirm the drug survival favorability of the IL-23 antagonist class, followed by IL-12/23, IL-17, and TNF inhibitors (13). Our data did not include ixekizumab, however, the study by Lockshin et al. showed that patients receiving ixekizumab displayed a 64% lower risk of discontinuation compared to TNFi (Hazard Ratio [HR] = 0.36; 95% CI: 0.27 to 0.47) and a 31% lower risk compared to other IL-17i (HR = 0.69; 95% CI 0.55 to 0.87) after adjusting for biologic experience and other covariates (30). ...
Background
Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.
Objectives
To identify physicians’ prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.
Methods
We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.
Results
A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.
Conclusion
This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.
... According to the survey, the overall switching rates for biologics at 12 and 24 months of treatment for psoriasis patients in the United States were 14.4 % and 26.0 %, respectively. Biologics were more commonly switched among patients with prior targeted immune modulators, those aged 51-64 years, and female patients [46]. However, the effectiveness of some biologics after switching was not satisfactory. ...
Abstracts
Background and objective
Biologics have revolutionized the management of plaque psoriasis and are flourishing. We aimed to construct a knowledge structure in this field through bibliometrics, analyze research trends and cutting-edge hotspots to inspire future research directions, and provide valuable references for clinical decisions.
Methods
Publications on biologics for plaque psoriasis in the Web of Science database core collection from 2004 to 2023 were searched. Bibliometric analysis and scientific knowledge mapping were performed with R, CiteSpace, and VOSviewer software.
Results
2,672 articles written by 9,474 authors from 67 countries were included in the study. The number of annual publications has steadily increased over the last 20 years. The most prolific countries, institutions, and authors were the United States, Novartis, and Prof. Reick K., respectively. Reference analysis categorized the research base of the field into 10 main clusters. "Efficacy" and "safety" were the most frequent keywords, and cluster analysis categorized the research in this area into four groups. Burst detection captured current hot keywords including interleukin (IL)-17 inhibitors, IL-23 inhibitors, "drug survival," "discontinuation," "Covid-19," "real-world," and "clinical features."
Conclusion
Global publications on biologics research in plaque psoriasis have grown steadily and rapidly over the past two decades. Efficacy and safety are the highest topics of concern for researchers, and IL-17 inhibitors, IL-23 inhibitors, real-world studies, efficacy prediction, and retreatment after biologics failure or discontinuation are current research hotspots.
... The need to alter biological treatment primarily arises due to four reasons: (I) inefficacy due to primary failure (not achieving a ≥ 50% Psoriasis Area and Severity Index [PASI] score improvement at 24 weeks of treatment); (II) inefficacy due to secondary failure (losing the efficacy that was present after commenc-ing treatment, also known as biologic fatigue); (III) adverse events; and (IV) other factors such as lack of compliance and unhealthy lifestyle habits (6)(7)(8)(9). ...
Objective: Psoriasis, a chronic inflammatory skin disease, significantly impacts patients' quality of life. Over the last decade, therapeutic goals have aimed to complete skin clearance and restore normal patient activities, minimizing the disease's impact on social, family, and work activities. Biologics have emerged as a promising solution to achieve better disease control without organ-specific side effects, helping meet these therapeutic goals. However, it was soon noticed that approximately 30% of patients do not sufficiently react to the therapy in the long term, and the need for switching biologics emerges. Findings: We present our experience with biologic switching over a specific period. Seventeen patients required a switch in biologic agents, with three undergoing a second switch. The cohort predominantly consisted of males (14 out of 17), with an average BMI of 29.81. The primary reasons for switching were secondary failure (loss of initial treatment efficacy), followed by primary failure. Adverse reactions were the least common cause, highlighting the satisfactory safety profile of biologics. One patient underwent dose escalation of secukinumab due to efficacy failure but ultimately ended up switching the biologic. Conclusion: Biologic agents approved for the treatment of psoriasis showed a favorable safety profile without compromising efficacy. The increasing demand for higher efficacy in psoriasis treatment aims to alleviate the disease's multifaceted impact on patients. It is anticipated that biologic switching, primarily due to inadequate therapeutic response and less frequently due to adverse reactions, will become more prevalent in clinical practice. Literature and our clinical experience suggest that constitutional factors influence treatment success. As new agents and targets emerge, the established standards for biologic switching may require ongoing revision.
... This recommendation is particularly pertinent when the oral route is preferred, or when "conventional" systemic agents have proven ineffective, are contraindicated, or are poorly tolerated. Moreover, apremilast is recommended for patients with concurrent conditions like psoriatic arthritis and those with pre-existing malignancies [29,30]. ...
... These findings seem to align with previous literature, highlighting low rates of therapy switches [31][32][33][34]. Specifically, in the Italian context, Giometto et al. (2022) reported a low overall switch rate (20%) with anti-IL drugs [30]. Their analysis of administrative databases in Tuscany aimed to evaluate the pattern of biologic drug use for psoriasis and revealed a higher persistence to newer biologic drugs compared to anti-TNF drugs (including etanercept and adalimumab). ...
Exceptional advances have been made with systemic treatment for psoriasis (PSO). However, that disease still represents a heavy burden in terms of impact on healthcare systems worldwide. This study comprehensively assesses medication adherence in a real world setting in Italy across all phases—initiation, implementation, and persistence—of PSO therapies. By distinguishing between switches and swaps, it provides unique insights into the patient’s own approach to prescribed therapy as well as clinical decision-making processes, enhancing our understanding of medication adherence and discontinuation in a real world daily setting. The study’s refined methodology for assessing persistence, considering variations in refill gaps and complex dosing regimens, shows that anti-interleukin (IL) therapies are associated with longer periods of adherence compared with other available therapeutic strategies. Among the selected drugs, ixekizumab and secukinumab were the ones with higher rate of treatment adherence at the expense of anti-TNF-α and anti-PDE4 agents. Notably, patients who opt for swaps are approximately 2.8 times more likely to discontinue their PSO therapy within one year. These findings carry practical implications for optimizing medication adherence, including tailored patient counseling, monitoring, and therapeutic adjustments, highlighting the need for a comprehensive and patient-centered approach to managing these conditions.
