Biologic treatment sequences in moderate-to-severe psoriasis

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Novel biologics drive increased biologic-switching for improved patient outcomes.
• Limited guidance exists for biologic treatment sequencing in Australia.
• This study investigates Australian biologic-switching patterns and influencing factors.

Purpose of the Study:

• To examine biologic treatment sequencing patterns in Australian tertiary dermatology centers.
• To identify factors contributing to biologic-switching among patients.
• To characterize the speed of treatment response for different biologics.

Main Methods:

• Retrospective analysis of 440 treatment courses from two Australian tertiary hospitals (2006-2020).
• Data collection included treatment sequences and Psoriasis Area and Severity Index (PASI) scores.
• Evaluation of time to achieve PASI-90 and PASI-100 for treatment response.

Main Results:

• Ustekinumab and adalimumab were common first-line biologics.
• Tumor necrosis factor-alpha (TNF-α) inhibitors had the highest switching rate (63.8%).
• Interleukin-17 (IL-17) inhibitors showed the most rapid response; switching was linked to higher BMI and psoriatic arthritis.

Conclusions:

• There is a growing adoption of novel biologics with improved safety and efficacy.
• Treatment sequencing decisions are influenced by patient characteristics and response thresholds.
• IL-17 inhibitors represent a rapid and effective treatment option.