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TOPLINE:

Interclass biologic switching is effective and safe in patients with psoriasis, though switching from an anti-tumor necrosis factor (anti-TNF)-alpha to an anti-interleukin (IL)-17A treatment was associated with higher risk for adverse events (AEs), according to a meta-analysis.

METHODOLOGY:

• To evaluate the safety and effectiveness of switching treatments after an initial biologic treatment fails, researchers conducted a meta-analysis of 24 randomized clinical trials published through January 25, 2025, which included 12,661 adults with psoriasis who switched from one biologic agent to another within the same class or in a different class.
• Eight switching categories were analyzed.
• The primary endpoint was the Psoriasis Area and Severity Index (PASI) 90 score, and secondary endpoints included safety.

TAKEAWAY:

• PASI 90 improved significantly in patients after interclass biologic switching both at week 4 (11 studies; odds ratio [OR], 6.53; 95% CI, 2.58-16.51) and long term (OR, 28.61; 95% CI, 12.89-63.47). All switches were effective in the short term, whereas most switches achieved a PASI 90 response in the long term, except for switches from anti-IL-17A agents to anti-IL-17A/F agents.
• Long-term, marked improvements were observed when switching from anti-TNF-alpha agents to anti-IL-23p19 agents (OR, 23.72; 95% CI, 4.29-130.98) and from anti-IL-12/23p40 agents to anti-IL-23p19 agents (OR, 19.87; 95% CI, 10.40-37.94).
• No major safety differences were observed overall, except for increased serious adverse events (AEs) when switching from an anti-TNF-alpha agent to an anti-IL-17A agent (OR, 2.45; 95% CI, 1.25-4.83).
• Switching from anti-TNF-alpha agents to anti-IL-23p19, anti-IL-17A, or anti-IL-12/23p40 agents was associated with infection rates of 0.62%, 0.54%, and 0.39%, respectively. The highest risk for Candida infection (0.16%) was observed when switching from anti-TNF-alpha agents to anti-IL-17A/F agents.
• Switching to a different biologic class showed comparable effectiveness and safety with continuing the same agent, with regards to AEs.

IN PRACTICE:

This systematic review and meta-analysis found that “interclass biologic switching was effective, and there were no safety differences for most patients,” the study authors wrote. “Switching to anti-IL-23p19, anti-IL-17A, or anti-IL-12/23p40 agents from anti-TNF-alpha agents posed the greatest risk of infection,” they added, recommending “vigilance for infections while switching to different biologics.”

SOURCE:

The study was led by Miao Zhang, MD, Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China, and was published online on August 6 in JAMA Dermatology.

LIMITATIONS:

Limitations included heterogeneity in study designs, potential differences between biologics and batch variability which could have affected effectiveness comparisons after switching, insufficient data for several comparisons.

DISCLOSURES:

The study was supported by the National Natural Science Foundation of China, the Key Discipline Construction Project of Shanghai’s 3-Year Action Plan for Strengthening the Construction of Public Health System, Shanghai Oriental Talent Program for Top-notch Project, CACMS Innovation Fund, Shanghai Healthy Special Project, The Shanghai 2022 Science and Technology Innovation Action Plan Medical Innovation Research Special Project, the Clinical Research Plan of Shanghai Shenkang Hospital Development Center, the High-level Chinese Medicine Key Discipline Construction Project, Evidence-based dermatology base sponsored by State Administration of Traditional Chinese Medicine, and the Shanghai Hospital Development Center Foundation. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.