High Rates of Therapy Switching Among Patients With Psoriasis Initiating Biologics

A study published in the Journal of Dermatological Treatment found that switching therapies is common in patients with psoriasis, with IL-23 inhibitors having the lowest risk of switching over 24 months, and factors such as prior targeted immune modulator use, age, and gender influencing switching rates. 

Current psoriasis treatment options for moderate-to-severe psoriasis include systemic medication, small-molecule drugs, biologic therapies, and phototherapy. Switching therapies is common, and understanding the factors influencing this switch can help optimize disease management and improve patient outcomes. Researchers sought to quantify real-world switching rates and characteristics among patients initiating biologics over 24 months.  

The study involved patients who were 18 years old or older and had been diagnosed with psoriasis at least twice and selected from a US-payer claims database (Merative MarketScan). The researchers analyzed the switching rates of patients who started using a new biologic medication over 24 months using Kaplan-Meier analysis. Additionally, they used multivariable Cox regression analyses to identify any patient characteristics that were associated with switching rates. 

In a study of 7997 patients, the overall treatment switch rates were found to be 14.4% at 12 months and 26.0% at 24 months. Comparatively, IL-23 inhibitors had the lowest risk of switching when compared to TNF, IL-17, and IL-12/23 inhibitors over the course of 24 months (P< .0001). The switch rates varied among specific biologics, with the lowest rates observed in patients treated with risankizumab at 8.5% and guselkumab at 15.7% over 24 months. Factors such as prior targeted immune modulator use, age, and female gender were found to be predictors of switching (adjusted hazard ratio; 1.23, 1.31, and 1.40, respectively; P≤.0005). 

“This real-world study demonstrates that switching among patients with psoriasis using biologics was common over 24 months across a large US cohort. Significant differences existed in switch rates based on the class of biologic with IL-23 inhibitors demonstrated the lowest risk of switching over 24 months,” said researchers. “Important predictors of switching among psoriasis patients were identified as prior TIM use, age, and female gender, which adds to the current evidence on treatment switch patterns to help inform treatment decisions.” 

Reference 

Armstrong AW, Patel M, Li C, et al. Real-world switching patterns and associated characteristics in patients with psoriasis treated with biologics in the United States. Journal of Dermatological Treatment. 2023;34:1. doi:10.1080/09546634.2023.2200870