SWITCHING between biologic treatments in psoriasis patients leads to faster and more stable improvements in skin condition, though it may increase the risk of infections, particularly when changing from anti-TNF-α agents to other biologic classes.
Psoriasis is a chronic inflammatory skin disease often treated with biologic therapies targeting specific immune pathways. Patients may need to switch biologics due to cost, reduced drug effectiveness, or side effects. However, evidence on the benefits and risks of switching between different biologic classes has been limited, prompting a comprehensive review to guide clinical decisions.
A systematic review and meta-analysis analysed 24 randomised clinical trials including 12,661 patients with psoriasis undergoing interclass biologic switching. The study primarily measured treatment effectiveness using the psoriasis area and severity index (PASI 90) and assessed safety by tracking adverse events. The odds of achieving PASI 90 at week 4 compared to baseline increased substantially (OR 6.53; 95% CI 2.58–16.51). Larger improvements were observed in PASI 90 (OR 28.61), PASI 75 (OR 11.11), and PASI 100 (OR 18.76) outcomes, indicating enhanced skin clearance. Safety profiles remained similar before and after switching with no significant differences in serious adverse events. However, infections were more frequent following switches from anti-TNF-α agents to anti-IL-23p19 (infection rate 0.62%), anti-IL-17A (0.54%), and anti-IL-12/23p40 agents (0.39%).
These results suggest that switching between biologics of different classes can provide improved and sustained clinical benefits for people with psoriasis, though clinicians should maintain vigilance for infections when making treatment changes. Future research with larger cohorts and longer follow-up is needed to better understand long-term safety and to optimise switching strategies across diverse patient populations.
Reference
Zhang M et al. Biopharmaceutical switching in psoriasis treatment: a systematic review and meta-analysis. JAMA Dermatol. Published online August 06, 2025. doi:10.1001/jamadermatol.2025.2714
