Interleukin-17 Inhibitors May Improve Psoriasis Symptoms When TNF Inhibitors Do Not

Among patients with psoriasis who discontinued a tumor necrosis factor (TNF) inhibitor due to lack of response, switching to an interleukin-17 inhibitor predicted drug persistence, according to results from a single-site study published online ahead of print in Dermatology and Therapy.

“The study results suggest that interleukin-17 inhibitors are a favorable option for patients who discontinue TNF inhibitors due to inadequate efficacy and need to switch to other agents,” wrote researchers from Jichi Medical University, Tochigi, Japan.

Researchers investigated drug survival of TNF inhibitors and subsequent biologic drugs in patients with psoriasis treated at Jichi Medical University Hospital between January 1, 2010, and July 31, 2021. Participants included 111 patients initially treated with adalimumab, 12 patients initially treated with certolizumab pegol, and 74 patients initially treated with infliximab. 

Drug survival among the three TNF inhibitors did not significantly differ, according to the study. Ten-year drug survival rates were 18% with infliximab and 14% with adalimumab. 

Some 137 patients discontinued TNF inhibitors for various reasons. For subsequent treatment, 105 patients opted for a biologic: 31 patients chose another TNF inhibitor; 19 patients, an interleukin-12/23 inhibitor; 42 patients, an interleukin-17 inhibitor; and 13 patients, an interleukin-23 inhibitor.

Among patients who stopped their initial TNF inhibitor specifically because of inadequate efficacy, female sex predicted discontinuation of a subsequent biologic, the study showed. Switching to an interleukin-17 inhibitor rather than a TNF inhibitor, however, predicted drug continuation.

“Nevertheless, one study reported a different result from ours in that drug survival of second-line biologics were not significantly different between intra-class and inter-class switching,” researchers wrote. “Future studies need to establish a strategy for drug switching.”

Reference:
Kishimoto M, Komine M, Kamiya K, et al. Drug survival of tumor necrosis factor-alpha inhibitors and switched subsequent biologic agents in patients with psoriasis: a retrospective study. Dermatol Ther. Published online May 19, 2023. doi:10.1007/s13555-023-00932-0