Switching Biologics for Psoriasis May Improve Outcomes Without Added Risk: Study

08/07/2025

KEY TAKEAWAYS

  • Switching between interclass biologics was associated with significant improvement in PASI scores in psoriasis patients experiencing bioloic failure, a new study in JAMA Dermatology indicated.

  • The study also showed a slight increase in infection rate when switching from anti–TNF-α agents.

  • The authors cautioned that long-term follow-up and safety data are needed for more authoritative results.

Plaque psoriasis patients who are unresponsive to initial biologics may derive benefit from switching to another drug class, according to a new  meta-analysis of 24 randomized controlled trials (RCTs).

The review looked at data from a total of 12,661 adult patients in eight biologic switching categories. The analysis focused on interclass and intraclass biologic switches due to primary effectiveness failure, biologic fatigue, adverse events, or cost barriers. The study authors looked at both Psoriasis Area and Severity Index (PASI) scores and patient-reported outcomes (PROMs), including the Dermatology Life Quality Index and Psoriasis Symptoms and Signs Diary.

The data showed clinical improvements in PASI scores after switching to a new biologic.  Between week one and week four, researchers observed an increase in PASI 90 response rates (OR, 6.53; 95% CI, 2.58 to 16.51), with significant and lasting gains in PASI 75, PASI 90, and PASI 100.

There were no differences in safety outcomes before and after switching. Rates of serious adverse events (OR = 1.63; 95% CI, 0.72 to 3.69), severe adverse events (OR, 1.40; 95% CI, 0.61-3.26), and treatment-related adverse events (OR = 1.79; 95% CI, 0.41 to 7.88) were consistent. Switching from anti–TNF-α therapies to IL-23p19, IL-17A, or IL-12/23p40 agents was associated with a slightly elevated infection risk for each option.

“With the introduction of biologics with diverse mechanisms of action, these options may become viable and potentially superior," the authors wrote. "However, further confirmatory data from larger patient cohorts and longer follow-up periods are required to obtain more conclusive results. Our results highlight the importance of vigilance for infections when switching biologics.”

Source: Zhang M, et al. JAMA Dermatology. 2025. doi:10.1001/jamadermatol.2025.2714

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