Sequential use of biologics in moderate-to-severe plaque psoriasis: case studies illustrating an individualized...

Biologics have added great value to the treatment of psoriasis; however, there is currently little guidance on which biologic to use and at what stage of disease, and even less guidance on how to switch therapy in the event of treatment failure or the occurrence of side-effects. Furthermore, drug switching may not always be essential in cases of biologic failure, and adding conventional systemics has a role in some patients. It is clear that we have limited data to support any particular policy in initiating and switching biologics in psoriasis, but a pragmatic approach to therapy is supported by the case reports described within this article. Specifically, the case studies include patients who were initiated on different biologics and subsequently switched to alternatives for a variety of reasons, such as unresponsiveness or a concomitant disease. As more evidence emerges from long-term studies and registry data, a clearer picture should emerge on how best to use biologics in different situations to aid successful treatment outcomes. Comparative studies are necessary before firm recommendations about sequential use can be made.