Switching biologics for psoriasis

Ormerod, Anthony

doi:10.1111/j.1365-2133.2010.09999.x

Cited by 16 publications

(14 citation statements)

References 14 publications

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“…The body of evidence on switching therapies in psoriasis indicate that individuals respond differently to the different biologics approved for treating moderate-to-severe psoriasis, even when the biologics share a mechanism of action targeting TNFa (75). Thus, failure on one agent does not predict future treatment failure with different agents, and prompt alteration of treatment should be a priority for patients who are failing to meet their goals given the wide range of therapies already available and in late-stage clinical development for the management of moderate-to-severe psoriasis.…”

Section: Discussionmentioning

confidence: 99%

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

Kerdel

Zaiac

2015

Dermatologic Therapy

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Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients’ cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end‐organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near‐complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate‐to‐severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients’ psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patient's clinical needs and treatment preferences.

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Section: Discussionmentioning

confidence: 99%

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

Kerdel

Zaiac

2015

Dermatologic Therapy

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“…Thus, primary and secondary failures occur in response to all inhibitors of TNFα agents, but the presence of antibodies cannot be considered the only explanation for loss of effectiveness. 17 …”

Section: Discussionmentioning

confidence: 99%

Anti-TNFα therapy in the management of psoriasis: experience of a state referral center

Silva

Rocha

Nobre

et al. 2014

An. Bras. Dermatol.

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BACKGROUNDPsoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis.OBJECTIVESWe report the experience of a state referral center that uses anti-TNFα agents for psoriasis.METHODSWe conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemar's tests. Associations were considered statistically significant when p-value<0.05.RESULTSForty-one subjects (55.40%) were male, with a mean age of 47.69±14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively.CONCLUSIONPost-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites.

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“…The wider availability of laboratory tests to detect serum drug levels or antidrug antibody levels just prior to the next injection might improve our ability to decide between intraclass or interclass switching [namely, antitumour necrosis factor (TNF) to anti‐p40 or vice versa ]. Even though intraclass switching has been reported to be effective, 15 it may also lead to worsening of psoriasis 16 . Indeed, switching between anti‐TNF antibodies is likely to be ineffective in the absence of antidrug antibodies (which might imply that loss of efficacy is not due to increased clearance of the drug) 17 .…”

Section: Cost‐effectiveness Calculations Of Dose Escalation Vs Switcmentioning

confidence: 99%

Dose escalation may be effective in patients with psoriasis after treatment failure or suboptimal response, but switching to adalimumab is the most cost-effective measure in different scenarios

Puig

2013

British Journal of Dermatology

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Switching biologics for psoriasis

Cited by 16 publications

References 14 publications

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

Anti-TNFα therapy in the management of psoriasis: experience of a state referral center

Dose escalation may be effective in patients with psoriasis after treatment failure or suboptimal response, but switching to adalimumab is the most cost-effective measure in different scenarios

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