Ethics Declarations: In France and Itlay, ethic declaration is not necessary for retrospective date. We only required the "non-opposition for participating to the study" Funding: No sources of funding were used to conduct this study or prepare this manuscript.

Background Biologics are the cornerstone of treatment of patients with moderate‐to‐severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time. Objectives The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents. Methods We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate‐to‐severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra‐class – i.e. within the same therapeutic class ‐ vs. inter‐class) in patients switching from a TNF‐alpha inhibitor using multivariate logistic regression. Results A total of 2153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF‐alpha inhibitor before 2016 mostly switched to ustekinumab, whereas those switching in 2016 or after mostly switched to an IL‐17 inhibitor. Patients switching from a first‐line TNF‐alpha inhibitor before 2016 were more likely to switch to another TNF‐alpha inhibitor compared with patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF‐alpha inhibitor rather than another therapeutic class of bDMARD compared with patients switching from adalimumab. Conclusion This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL‐17 inhibitors.

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Background Little is known about phototype and the response to systemic treatment in psoriasis. Objective To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype. Methods We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on PASI 90 and DLQI 0/1. Results Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, more frequently initiated ustekinumab. Patients in the phototype V-VI group maintained the first sequence of biologic as the other phototype groups, even though the proportion of patients reaching the PASI 90 and DLQI 0/1 at 12 months was lower in this group than other groups. Conclusion Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. Phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient.