Transitioning from IL-23 inhibitors to IL-17 inhibitors in PsO: A BIOREP registry analysis

Results from a real-world retrospective analysis of the BIOREP registry, evaluating efficacy and drug survival in patients with psoriasis (PsO) who switched from an interleukin (IL)-23 inhibitor to an IL-17 inhibitor, were published in the Journal of Dermatological Treatment by Rob et al. Of 102 patients who switched, 92 did so due to insufficient efficacy and were included in the analysis. Efficacy outcomes included the proportions of patients achieving ≥75% reduction in Psoriasis Area and Severity Index (PASI75) and absolute PASI ≤1 from baseline at 3 and 12 months. 

Key data: At 3 and 12 months, 82.6% and 73.5% of patients achieved PASI75, respectively; responses did not significantly differ between IL-17 inhibitors. Absolute PASI ≤1 was achieved by 66.3% of patients after 3 months and 52.9% after 12 months. Bimekizumab demonstrated the highest rate of absolute PASI ≤1 at 3 months (86.5%) compared with brodalumab (53.3%; p < 0.05), ixekizumab (54.5%; p < 0.01), and secukinumab (44.4%; p < 0.05). Overall drug survival probability was 79.5% at 12 months and 68.1% at 24 months. Drug survival at 24 months was lower in patients with obesity than in those without (60.1% vs 81.0%). 

Key learning: Switching patients with PsO and an inadequate response to IL-23 inhibitors to IL-17 inhibitors represents an effective therapeutic strategy for achieving treatment goals during the first year, although obesity may be a negative long-term prognostic factor for drug survival.