Switching biologics for psoriasis

Etanercept was the first of the tumour necrosis factor (TNF) inhibitors to be approved for the treatment of psoriasis. In addition to the failure to respond adequately to this therapy (primary nonresponse), loss of the initial response over time (secondary nonresponse) is not uncommon. A degree of uncertainty exists about the best management of these patients. It may be convenient for those who reimburse therapy to disallow switching to an alternative TNF inhibitor on the basis of lack of evidence for its efficacy in this situation, so more evidence to support the practice of switching biologics is welcome. In this edition of the BJD two articles1, 2 describe the results of switching to an alternative TNF inhibitor. While the results are not quite as favourable as those seen in clinical trials of biologic‐naive patients, a worthwhile response was seen in most patients, lending support to what is becoming a common practice of switching biologics to achieve long‐term control of psoriasis. A third paper in this edition concerns the ‘real world’ experience with adalimumab including 31 patients who had already received another anti‐TNF therapy. Sixty‐eight per cent of these patients responded, as defined by the National Institute of Health and Clinical Excellence (NICE) criteria and the British Association of Dermatologists (BAD) guidelines, achieving at least Psoriasis Area and Severity Index (PASI) 75 or PASI 50 plus a five‐point improvement in the Dermatology Life Quality Index (DLQI) score, after 16 weeks of adalimumab therapy.3