Sustainability and switching of biologics for psoriasis

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.