Prescribing and switching patterns of biologic therapy in patients with psoriasis: real-world experience

The advent of new biologic agents in recent years has increased treatment options for patients with psoriasis.

To evaluate the prescribing and switching patterns of biologic agents used for psoriasis in Malaysia.

Data were obtained from the Malaysian Psoriasis Registry from January 2011 to September 2022. All patients treated with biologic agents were included. Those with at least two entries were selected for subgroup analysis to evaluate switching patterns. 'Continuous therapy' was defined as those who continued with the same biologic in the subsequent follow-up, whereas those who switched to another type of biologic were defined as 'switching therapy'.

Of 25 468 patients, 555 (2.2%) received at least 1 biologic agent. The mean age of patients on biologics was 42.6 years, with a male-to-female ratio of 1 : 0.8. Of 645 biologic prescriptions, secukinumab was the most common (37.8%), followed by ustekinumab (27.9%), adalimumab (18.3%) and guselkumab (4.5%). Etanercept had the longest mean usage duration at 46.2 months. Eighty patients (14.4%) had their biologic agent switched. The most frequent switch pattern was from anti-interleukin (IL)-12/23 to anti-IL-17 (20 of 80, 25%), followed by tumour necrosis factor inhibitors to either anti-IL-17 (13 of 80, 16%) or anti-12/23 (11 of 80, 14%). Anti-IL-17 was the preferred agent on switching (37 of 80, 46%). Primary and secondary lack of efficacy were the most common reasons for switching (46% and 25%, respectively). Concurrent systemic therapy was reported in 21.6% of cases (120 of 555). Of these, 76.6% (92 of 120) had received methotrexate.

Up to 2% of the patients with psoriasis received treatment with biologics. Anti-IL-17 was the preferred first- and second-line biologic agent used in Malaysia.