Sustainability and switching of biologics for psoriasis


  • Ramesh Aravamuthan Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India
  • Sampath Vadivelu Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India
  • Shabari Arumugam Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India



Biologic switching, Psoriasis, Infliximab, Etanercept, Secukinumab


Background: The optimal treatment guidelines for psoriasis using biologics are limited. In addition to this, the administration of the original biologic may be terminated or switched to another biologic due to inefficacy, adverse effects, and economic burden. Our objective is to compare demographic characteristics between switched and non-switched groups and to identify the reason for switching among various original biologics in our setup.

Methods: We performed a retrospective cohort analysis of psoriatic patients on biologic treatment. Our analysis involved 42 patients, of which 19 were switched to the second biologic. The demographic characteristics and reason for biologic switching were noted and data analyzed between switched and non-switched groups.

Results: First line therapies were infliximab (IFX, n=10), etanercept (ETN, n=21), secukinumab (SEC, n=11) and switching required in 3 (30%), 11 (52%), 5 (45%) patients respectively. The reason for switching, in general, in our setup is inefficacy (n=10; 53%), non-availability (n=8; 42%) and adverse event (n=1; 5%). Small number of patients, single-centre study and retrospective design were the limitations.

Conclusions: Infliximab showed the least tendency to switch to the second biologic, however, it had adverse reactions. Inefficacy is the primary cause of switching. To the best of our knowledge, our study on Biologics switching is the first of its kind in the Indian scenario.


Schon MP, Boehncke WH. Psoriasis. N Engl J Med. 2005;352(18):1899-912.

Torii H, Nakagawa H. Japanese Infliximab Study investigators. Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. A randomized, double-blind, placebo-controlled multicenter trial. J Dermatol Sci. 2010;59(1):40-9.

Gottlieb AB, Evans R, Li S, Dooley LT, Guzzo CA, Baker D, et al. Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2004;51(4):534-42.

Menter A, Tyring SK, Gordon K, Kimball AB, Leonardi CL, Langley RG, et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol. 2008;58(1):106-15.

Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet Lond Engl. 2008;371(9625):1665-74.

Glintborg B, Ostergaard M, Krogh NS, Andersen MD, Tarp U, Loft AG, et al. Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor α inhibitor therapy: results from the Danish Nationwide DANBIO Registry. Arthritis Rheum. 2013;65(5):1213-23.

Vender R. An open-label, prospective cohort pilot study to evaluate the efficacy and safety of etanercept in the treatment of moderate to severe plaque psoriasis in patients who have not had an adequate response to adalimumab. J Drugs Dermatol JDD. 2011;10(4):396-402.

Lumig PPM, Lecluse LLA, Driessen RJB, Spuls PI, Boezeman JB, Kerkhof PCM, et al. Switching from etanercept to adalimumab is effective and safe: results in 30 patients with psoriasis with primary failure, secondary failure or intolerance to etanercept. Br J Dermatol. 2010;163(4):838-46.

Mazzotta A, Esposito M, Costanzo A, Chimenti S. Efficacy and Safety of Etanercept in Psoriasis After Switching from Other Treatments: An Observational Study. Am J Clin Dermatol. 2009;10:319-24.

Honda H, Umezawa Y, Kikuchi S, Yanaba K, Fukuchi O, Ito T, et al. Switching of biologics in psoriasis: Reasons and results. J Dermatol. 2017;44(9):1015-9.

Bayaraa B, Imafuku S. Sustainability and switching of biologics for psoriasis and psoriatic arthritis at Fukuoka University Psoriasis Registry. J Dermatol. 2019;46(5):389-98.

Hassett B, Singh E, Mahgoub E, Brien OJ, Vicik SM, Fitzpatrick B. Manufacturing history of etanercept (Enbrel®): Consistency of product quality through major process revisions. mAbs. 2018;10(1):159-65.

Gall JS, Kalb RE. Infliximab for the treatment of plaque psoriasis. Biol Targets Ther. 2008;2(1):115-24.

Scheinfeld N. Adalimumab (HUMIRA): a review. J Drugs Dermatol JDD. 2003;2(4):375-7.

Mazumdar S, Greenwald D. Golimumab. mAbs. 2009;1(5):422-31.

Cingoz O. Ustekinumab. mAbs. 2009;1(3):216-21.

Fala L. Cosentyx (Secukinumab): First IL-17A Antagonist Receives FDA Approval for Moderate-to-Severe Plaque Psoriasis. Am Health Drug Benefits. 2016;9:60-3.

Jayaraman K. Biocon’s first-in-class anti-CD6 mAb reaches the market. Nat Biotechnol. 2013;31(12):1062-3.

Markham A. Tildrakizumab: First Global Approval. Drugs. 2018;78(8):845-9.

Machado A, Torres T. Guselkumab for the Treatment of Psoriasis. Bio Drugs Clin Immun other Bio pharm Gene Ther. 2018;32(2):119-28.

Banaszczyk K. Risankizumab in the treatment of psoriasis - literature review. Reumatologia. 2019;57(3):158-62.

Kim WB, Marinas JEC, Qiang J, Shahbaz A, Greaves S, Yeung J. Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study. J Am Acad Dermatol. 2015;73(2):237-41.

Kleyn CE, Griffiths CEM. Infliximab for the treatment of psoriasis. Expert Opin Biol Ther. 2006;6(8):797-805.

Lecluse LLA, Piskin G, Mekkes JR, Bos JD, Rie MA. Review and expert opinion on prevention and treatment of infliximab-related infusion reactions. Br J Dermatol. 2008;159(3):527-36.

Wee JS, Petrof G, Jackson K, Barker JNWN, Smith CH. Infliximab for the treatment of psoriasis in the U.K.: 9 years’ experience of infusion reactions at a single centre. Br J Dermatol. 2012;167(2):411-6.

Cheifetz A, Smedley M, Martin S, Reiter M, Leone G, Mayer L, et al. The incidence and management of infusion reactions to infliximab: a large center experience. Am J Gastroenterol. 2003;98(6):1315-24.

Reich K, Nestle FO, Papp K, Ortonne JP, Evans R, Guzzo C, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet Lond Engl. 2005;366(9494):1367-74.

Baert F, Noman M, Vermeire S, Assche VG, Haens DG, Carbonez A, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med. 2003;348(7):601-8.

Piaserico S, Cazzaniga S, Chimenti S, Giannetti A, Maccarone M, Picardo M, et al. Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: results from the Italian Psocare registry. J Am Acad Dermatol. 2014;70(2):257-262.

Yamauchi P, Bissonnette R, Teixeira H, Valdecantos W. Systematic review of efficacy of anti–tumor necrosis factor (TNF) therapy in patients with psoriasis previously treated with a different anti–TNF agent. J Am Acad Dermatol. 2016;75.

Gottlieb AB, Kalb RE, Blauvelt A, Heffernan MP, Sofen HL, Ferris LK, et al. The efficacy and safety of infliximab in patients with plaque psoriasis who had an inadequate response to etanercept: results of a prospective, multicenter, open-label study. J Am Acad Dermatol. 2012;67(4):642-50.

Sator P, Richter L, Saxinger W, Vasiljevic M, Stingl G. Adalimumab in the treatment of moderate-to-severe chronic plaque psoriasis in patients switching from other biologics. J Eur Acad Dermatol Venereol. 2015;29(9):1742-9.

Bhutani T, Koo J. Paradoxical worsening of psoriasis when switching from etanercept to adalimumab: a case series. J Dermatol Treat. 2011;22(2):75-8.

Chiricozzi A, Conti A, Burlando M, Odorici G, Gaiani F, Panduri S, et al. Switching from Secukinumab to Ustekinumab in Psoriasis Patients: Results from a Multicenter Experience. Dermatol Basel Switz. 2019;235(3):213-8.

Georgakopoulos JR, Phung M, Ighani A, Lam K, Yeung J. Biologic switching between interleukin 17A antagonists secukinumab and ixekizumab: a 12-week, multicenter, retrospective study. J Eur Acad Dermatol Venereol. 2019;33(1):7-8.

Sherman S, Cohen SE, Laish AI, Hodak E, Pavlovsky L. IL-17A Inhibitor Switching - Efficacy of Ixekizumab Following Secukinumab Failure. A Single-center Experience. Acta Derm Venereol. 2019;99(9):769-73.

Mrowietz U, Jong EMGJ, Kragballe K, Langley R, Nast A, Puig L, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol JEADV. 2014;28(4):438-53.

Ormerod AD. Switching biologics for psoriasis. Br J Dermatol. 2010;163(4):667-9.

Brezinski EA, Armstrong AW. Strategies to maximize treatment success in moderate to severe psoriasis: establishing treatment goals and tailoring of biologic therapies. Semin Cutan Med Surg. 2014;33(2):91-7.






Original Research Articles