With many biologics now available for patients with moderate-to-severe plaque psoriasis, physicians may find themselves transitioning among them to optimize treatment and improve quality of life, according to Ron Vender, M.D., associate clinical professor of dermatology, McMaster University, and founder and director, Dermatrials Research, Inc, Hamilton, Ontario, Canada.
Switching among agents is one strategy to consider when patients fail to achieve an adequate response to biologic therapy, experience secondary failure with loss of efficacy over time, or develop an adverse reaction, he says. Dose or dosing interval adjustments may also be considered. In addition, there are also reports that repeating the induction phase regimen can help patients who are secondary failures.
What constitutes treatment failure is another issue to consider. The high PASI 90 response rates that can be achieved with the newer biologics have raised the bar. Individual patients, however, will differ in their outcome expectations, and use of adjuvant topical or phototherapy might be reasonable interventions to address localized resistant plaques in patients who fail to clear.
“Before making a switch for primary or secondary failure, clinicians also need to rule out a role for treatment nonadherence,” Dr. Vender says.
Dr. Vender recently published a paper that aims to provide clinicians with practical guidance for changing biologic therapy in patients being treated for moderate-to-severe plaque psoriasis who are deemed efficacy failures or develop a safety concern.1 He summarizes findings from relevant literature and offers recommendations about how and what biologic to transition to given different clinical scenarios.
Dr. Vender has received grants and/or research support from companies that market biologics for treatment of plaque psoriasis. He received no financial support for the research, authorship, or publication of his article on transitioning between biologics.
Vender R. Transitioning between biologics. Skin. 2019;3(6):374-80.