Biologic Switching Patterns, Discontinuation in Psoriasis Investigated in New Study

An analysis of biologic drug use patterns in patients with psoriasis from Tuscany, Italy, associated etanercept with the highest frequency of switching to other biologics; secukinumab and ustekinumab were linked with the lowest risk.

Certain biologics may increase the risk of switching and discontinuation in the management of psoriasis, according to study findings published in International Journal of Environmental Research and Public Health.

With the emergence of several effective biologic therapies approved for the management of moderate to severe psoriasis, risk of switching and discontinuation has become of notable concern due to the inferior patient outcomes associated with such occurrences.

“The reasons for discontinuing the first biological or switching to another one might be primary or secondary failure of treatment, intolerance, or occurrence of adverse events,” explained the study authors. “Despite the frequency of switches in clinical practice, it is unclear which drugs are most frequently switched to, and no clinical recommendations are available.”

Noted as the first study aiming to investigate all switches in clinical practice for biologic therapies in psoriasis, the researchers conducted a drug-utilization analysis based on administrative data banks of Tuscany, Italy.

A total of 1839 patients with moderate to severe psoriasis (mean [SD] age, 51.6 [15.2] years; 52.9% female) indicated as new users of etanercept (n = 758), infliximab (n = 159), adalimumab (n = 770), ustekinumab (n = 115), or secukinumab (n = 37) between January 1, 2011, and December 31, 2016 ,were recruited for the study. Participants were followed for 3 years after the first dispensation of a biologic drug for psoriasis or the patient’s death, whichever came first.

“For each subject, we defined the state as the weekly coverage of one of the biologic drugs of interest," the authors wrote. "We then defined the switch as the change from a state to another one.”

Of the study cohort, 96.0% reached the end of follow-up, with the remaining patients being censored for cancer (n = 33), death (n = 20), or pregnancy (n = 19). The total number of patients using etanercept, infliximab, or adalimumab decreased over time, whereas the number of patients using ustekinumab remained constant and those given secukinumab increased. The proportion of patients not covered by any psoriasis biologic drug also increased.

Most participants did not report any switch to another biologic drug (73.1%). Among the 5 index-drug groups, the higher frequency of 1 switch was in the new users of infliximab (23.3%), and the higher frequency of 2 or more switches was in the new users of etanercept (8.0%), with adalimumab most often being the second choice provided.

Among new users of adalimumab, one-third showed a continuous behavior, with other patients either switching to no biologic therapy or to etanercept/ustekinumab. The mean time to first switch was 224 (219) days for secukinumab, 391 (305) days for etanercept, 409 (278) days for infliximab, 454 (296) days for adalimumab, and 485 (276) days for ustekinumab.

“Important in this respect is the different frequency of administration in the maintenance phase: that of etanercept is weekly, or even biweekly during the first 3 months of treatment, whereas that of ustekinumab is quarterly,” said the researchers.


Giometto S, Tillati S, Baglietto L, et al. Use of biological drugs for psoriasis: A drug-utilization study using Tuscan administrative databanks. Int J Environ Res Public Health. Published online June 2, 2022. doi:10.3390/ijerph19116799