Comparison of the effectiveness and treatment patterns of anti-IL-23 and anti-IL-17A after anti-IL-17A failure in psoriatic patients: a single-center, retrospective study

Background: An increasing number of psoriasis patients are experiencing secondary failure with interleukin (IL)-17A inhibitors, highlighting the urgency to identify effective switching strategies.

Objectives: Evaluated the effectiveness and treatment patterns of intraclass versus interclass switching therapies in psoriasis patients experiencing secondary failure to IL-17A inhibitors over a 28-week period.

Methods: This retrospective analysis included psoriasis patients who experienced secondary failure of IL-17A inhibitors and subsequently switching to either an IL-23 inhibitor (inter-class switching group) or an alternative IL-17A inhibitor (intra-class switching group).

Results: 80 patients were enrolled, including 47 in the intra-class switching group and 33 in the inter-class switching group. The mean psoriasis area and severity index (PASI) scores and dermatology life quality index (DLQI) scores were significantly lower in the intra-class switching group compared to the inter-class switching group at each time point over 28 weeks (P<0.05). The discontinuation rate was significantly higher in the inter-class switching group (24.1%) compared to the intra-class switching group (2.7%; P<0.05). Previous exposure to ≥2 biologics working on different pathways was identified as a risk factor for treatment failure in the inter-class switching group.

Conclusion: Intra-class switching provides superior treatment outcomes compared to inter-class switching in patients experiencing secondary failure to IL-17A inhibitors.