VANCOUVER, B.C. – When adults with moderate to severe psoriasis fail one anti-TNF agent, most will still respond to another anti-TNF or ustekinumab, according to data from an investigation at two University of Toronto hospitals.
Researchers reviewed the outcomes of 155 patients who were switched to a second biologic after failing at least 12 weeks of treatment with their first, which was usually an anti–tumor necrosis factor (TNF) agent. Ustekinumab was often plan B. Of the 65 patients switched to it after failing initial anti-TNF therapy, 47 (72%) had a significant response, defined as at least a 75% improvement in the Psoriasis Area & Severity Index score (PASI 75) after 12 weeks of treatment. Ten more patients (15%) achieved PASI 50.
Mr. Whan Kim
Meanwhile, of the 82 switched to a second anti-TNF, 48 (59%) reached PASI 75 and more achieved PASI 50 after 12 weeks.
“Clinicians switch biologics all the time, but there are no clear guidelines” on how to do it, “so it was worth looking into,” investigator Whan Kim, a medical student at McMaster University in Hamilton, Ont., said at the World Congress of Dermatology.
“This is one of the largest studies to date that determines the effectiveness of real-life switching of biologic therapies in patients with moderate to severe psoriasis. This study suggests switching to ustekinumab would induce the highest response rate – 72% was surprising,” he said. “Failing a biologic doesn’t preclude responding to another one. Don’t give up,” Mr. Kim added.
The team did find, however, that patients with two previously failed biologics were about half as likely to respond to a third biologic, compared with those who had failed just one (odds ratio, 0.474; 95% confidence interval, 0.23-0.96; P = 0.04).
The patients averaged 50 years of age and had psoriasis for approximately 17 years. Half had psoriatic arthritis, and the study population included slightly more women than men. Of the 155 patients, 93 failed initial treatment with etanercept. Seven of 12 (58%) who switched to infliximab, 24 of 43 (56%) who switched to adalimumab, and 27 of 38 (71%) who switched to ustekinumab achieved PASI 75.
Twenty-three failed initial infliximab. Three of four (75%) who switched to etanercept, four of seven (57%) who switched to adalimumab, and nine of 12 (75%) who switched to ustekinumab had a significant response.
Thirty-one patients failed initial adalimumab. Seven of 11 (64%) who switched to etanercept, 3 of 5 (60%) who switched to infliximab, and 11 of 15 (73%) who switched to ustekinumab had a significant response.
Of eight patients who failed initial ustekinumab, three (38%) switched to etanercept and had a significant response after 12 weeks.
There was no outside funding for the work, and Mr. Kim had no disclosures. The senior investigator is a speaker, consultant, and investigator for AbbVie, Amgen, and Janssen.