Patients with psoriasis frequently switched biologic medications in a 24-month period, and interleukin (IL)-23 inhibitors were associated with the lowest risk for switching, according to study findings published in Journal of Dermatological Treatment.

Researchers conducted a retrospective cohort study sought to determine real-world switch rates in patients who initiated use of biologics for psoriasis treatment over 24 months using data from the Merative MarketScan Commercial and Medicare Supplemental Research databases from January 1, 2016 to March 31, 2022.

The participants were aged 18 years and older and initiated use of a new biologic that was approved by the US Food and Drug Administration for psoriasis between January 1, 2018 and September 30, 2021. They had at least 2 confirmed psoriasis diagnosis claims on separate days associated with a diagnostic code related to plaque or vulgaris psoriasis.

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Switching rates were defined as the proportion of patients who switched to a new targeted immune modulator (TIM) in 24 months of follow-up after treatment initiation.

The analysis included 7997 participants with psoriasis, comprising those who received IL-23 inhibitors (n=2886; 36.1%), IL-17 inhibitors (n=1855; 23.2%), tumor necrosis factor inhibitors (TNFis; n=2286; 28.6%), and IL-12/23 inhibitors (n=970; 12.1%). The participants were a mean age of 44.9 years (SD 12.8), and 48.3% were women.

Treatment switch rates for all biologics were 14.4% at 12 months and 26.0% at 24 months, with significant differences occurring among biologic classes in participants with psoriasis during 24 months (P <.0001). Overall, IL-23 inhibitors had the lowest switch rates, with 6.4% switching at 12 months and 12.7% switching at 24 months. Conversely, TNF inhibitors had the highest switch rates, with 24.8% switching at 12 months and 39.1% switching at 24 months.

After adjusting for baseline characteristics, IL-23 inhibitors also were associated with the lowest risk for switching. The participants who received TNFis, IL-17, and IL-12/23 inhibitors were 4.2 (95% CI, 3.6-4.9), 2.4 (95% CI, 2.1-2.9), and 2.2 (95% CI, 1.8-2.7) times more likely to switch compared with those who were treated with IL-23 inhibitors (P <.0001), respectively, according to multivariable Cox regression. A majority of patients who switched biologic therapies switched to newer-generation biologics, with 35.2% switching to IL-17 inhibitors and 37.4% switching to IL-23 inhibitors.

Significant differences occurred in switch rates among specific biologics (P <.0001). In a 12-month period, the lowest switch rates were for risankizumab at 4.5% vs all other biologics (P <.05), followed by guselkumab at 8.2%. Over 24 months, the lowest switch rates occurred with risankizumab at 8.5% vs the other biologics (P <.05), followed by guselkumab at 15.7%.

The results were consistent after adjustment for baseline characteristics, indicating that risankizumab had the lowest switch rates compared with all included individual biologics.

Previous TIM use, age (51-64 years), and female sex were predictors of switching in patients with psoriasis (adjusted hazard ratio, 1.2, 1.3, and 1.4, respectively; P ≤.0005), with consistent findings observed for individual biologics (P ≤.0005).

Limitations of the study include the fact that the reasons for switching cannot be determined in claims data, and no conclusions on efficacy or safety can be made. Also, the claims data used for billing health plans may be subject to data errors, and a claim for a filled prescription may not indicate actual use of the drug.

“Failure of an initial biologic treatment may have a consequence of reduced patient satisfaction and lead to patient hesitation to try alternative biologics; therefore, it is important to explore challenges to switching therapy and consider patient-reported outcomes including quality of life in treatment decisions,” conclude the researchers.

Disclosure: This work was supported by AbbVie Inc. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Armstrong AW, Patel M, Li C, Garg V, Mandava MR, Wu JJ. Real-world switching patterns and associated characteristics in patients with psoriasis treated with biologics in the United States. J Dermatolog Treat. Published online May 8, 2023. doi:10.1080/09546634.2023.2200870

This article originally appeared on Dermatology Advisor