Sequencing of Targeted Therapy in Psoriasis: Does it Matter? Am J Clin Dermatol 2024 Sep;25(5):795-810
Date
07/14/2024Pubmed ID
39003351DOI
10.1007/s40257-024-00874-zScopus ID
2-s2.0-85198405473 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
With the continued development of biologics for the treatment of psoriasis, some patients have achieved optimal control, but a recommended biologic sequence if a biologic fails to initially improve the skin, termed primary nonresponse, or loses efficacy after initial improvement, termed secondary nonresponse, is still lacking. Primary and secondary nonresponse can occur with any class of biologics, and the type of nonresponse can drive the choice of whether to switch within a biologic class or to a different biologic class. The choice of biologic can also be challenging when managing psoriasis and concomitant psoriatic arthritis, as treatment differs on the basis of the severity of both diseases and further classification of axial and peripheral joint involvement. When choosing a biologic, each patient's comorbidities and preferences are also taken into account to provide the optimal therapy. With this lack of an established biologic sequence after biologic failure, the objective of our review is to define a therapy sequence for the tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitor classes in the treatment of psoriasis and psoriatic arthritis. Our proposed biologic sequence was derived through an analysis of the efficacy of each biologic class, primary and secondary nonresponse rates from clinical trials, and clinical experience with expert opinion.
Author List
Boswell ND, Singla S, Gordon KBAuthors
Kenneth Brian Gordon MD Professor in the Dermatology department at Medical College of WisconsinShikha Singla MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Arthritis, PsoriaticBiological Products
Dermatologic Agents
Drug Substitution
Humans
Interleukin-17
Interleukin-23
Molecular Targeted Therapy
Psoriasis
Severity of Illness Index
Treatment Failure
Treatment Outcome
Tumor Necrosis Factor-alpha
