Age and psoriatic arthritis are important predictors of biologic agent switch in psoriasis.

Abstract

BACKGROUND\nThe demand of biologic switching is increasing for different reasons. We aimed to define reasons for switching biologics and possible predictors for switching risk, and to estimate data on drug survival.\n\n\nMETHODS\nOne-hundred and fifteen patients treated with biologics for at least 12 consecutive months who switched to a second, third, and/or fourth biologic were eligible for this retrospective study. The data is extracted from the electronic medical records of the hospital. Patients were divided into 2 groups as switched once, and switched twice or more. Drug survival rates were calculated using the Kaplan-Meier method, and the log rank test was used to compare drug survival.\n\n\nRESULTS\nAll patients switched at least one, 36 patients switched twice, and 9 switched thrice. First-, second, and third-line biologics were mostly switched due to secondary lack of efficacy for skin disease. Each unit increase in age decreased the risk of having ≥2 switches 4% (p=0.038, OR:0.964, 95%CI: 0.93-0.998), whereas PsA increased the risk of having ≥2 switches 2.69-fold (p=0.026, OR:2.69, 95%CI:1.12-6.44). There was significant difference between biologics in terms of drug survival (p=0.001). Adalimumab had a lower drug survival compared to ustekinumab (p<0.001) and secukinumab (p=0.003) in transition from second-line biologic to third-line biologic.\n\n\nCONCLUSION\nSwitching biologics was most commonly due to secondary lack of efficacy for skin disease. Lower ages and the presence of PsA were associated with a higher need for switching in long-term. Ustekinumab and secukinumab are superior to adalimumab in clinical practice in terms of drug survival of second-line biologics.