Treatment sequences in moderate-to-severe psoriasis: a hospital-based retrospective analysis

For moderate-to-severe psoriasis, clinical guidelines recommend biologic treatments after failure of at least one traditional systemic therapy. Biologics target different pathways, but a common challenge is loss of efficacy, often requiring a switch. This study explores real-world therapeutic management of moderate-to-severe psoriasis, focusing on biologic treatments. A retrospective study was conducted using health records of adult patients currently receiving biologics at Sant’Orsola Hospital in Bologna. Therapeutic sequences were investigated using state sequence analysis. Within-sequence Shannon entropy was calculated and used as the outcome in linear regression models. A directed acyclic graph informed the hierarchical regression models to identify factors influencing treatment duration. The cohort included 364 patients. Adalimumab was the most common first-line biologic (27%), followed by secukinumab (18%) and etanercept (16%). Nearly half of patients (48%) switched treatments. Increasing age was associated with lower sequence heterogeneity (β = -0.001, <i>p</i> = 0.002). Ustekinumab demonstrated the longest median treatment duration (1,841 days), while etanercept had the shortest (639 days). After adjusting for confounding variables, ustekinumab maintained its positive effect on treatment duration (β = 0.285, <i>p</i> = 0.009). The treatment duration for ustekinumab was encouraging, supporting its potential role as a durable option in these patients. Psoriasis is a long-lasting skin condition that can seriously affect people’s quality of life. When psoriasis is moderate-to-severe, doctors often prescribe medicines called biologics if other treatments, like traditional pills, stop working. Biologics work by blocking specific parts of the immune system that cause psoriasis. However, it is common for these medicines to lose their effect over time, meaning patients often need to switch to a different one.This study looked at how people with moderate-to-severe psoriasis are treated with biologics in real life. Researchers examined the medical records of 364 adults treated at Sant’Orsola Hospital in Bologna, Italy. They analyzed which biologic was used first, how often people switched treatments, and how long each medicine lasted before a switch was needed.The study found that almost half of the patients changed biologic at least once. Adalimumab was the most common first choice, but ustekinumab turned out to have the longest treatment duration. On average, patients stayed on ustekinumab for about 5 years, while etanercept had the shortest duration of about 2 years. Older patients tended to switch treatments less often.Overall, these findings suggest that ustekinumab may be a good long-term option for some people with psoriasis. Understanding how patients move from one treatment to another can help doctors make better choices and improve long-term care. More studies like this one can help ensure that people with psoriasis receive the best possible treatment for their needs