Real-world Switching Patterns and Associated Characteristics in Patients with Psoriasis Treated with Biologics

Multiple parameters define the treatment course with biologics for a psoriatic patient while treatment switches are often associated with worse prognosis. The purpose of this study was to describe the switching patterns of biologics for psoriasis in the Greek market landscape and to detect associated factors that may impact the evolvement of selected therapy. This is a retrospective cohort study using data recorded in the nationwide digital prescription database of Greece. Patients with a diagnosis for psoriasis, with or without concomitant psoriatic arthritis (PsA), who had initiated a biologic treatment between January 1st 2016 and December 31st 2020 were included. Overall, 6,772 biologic-naïve patients were included. Patients treated with infliximab demonstrated the highest switching rates while those treated with ustekinumab and secukinumab the lowest. Secukinumab and brodalumab had the lowest rates of switch or re-initiation 12 months after initiation. Switches from secukinumab to brodalumab and ustekinumab and from adalimumab to secukinumab and ustekinumab were more frequently observed. The risk was significantly higher for patients with concurrent PsA and for women, while patients treated with brodalumab, secukinumab and ustekinumab demonstrated a lower risk compared to adalimumab. Antibodies against interleukins have lower switching rates compared to more traditional biologics. The time to switch is longer for the first transition highlighting the necessity to establish long term therapeutic options early in the treatment course. Concurrent PsA or gender may have a significant impact in outcome, thus they need to be considered before the launch of a selected therapy.