Supplementary Material for: Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience

Background/Objective: The purpose of our study was to provide evidence on the treatment choices, reasons, and results of switching between biologic agents in treating patients with psoriasis. Methods: We conducted a retrospective database search of six tertiary referral centers for psoriasis patients between January 2007 and May 2019. We analyzed patient and treatment characteristics of all patients in the registry. Results: We enrolled 427 psoriatic patients treated with biologics, and 145 (34%) required a switch to another biologic. The reasons for discontinuing the first biologic agent were inefficacy (n = 106, 62.4%), adverse events (n = 28, 16.5%), and others (n = 36, 21.2%). At week 12, there was a 67.7% reduction in the Psoriasis Area and Severity Index (PASI) score of patients treated with their first biologic, and 51.4% reduction for the second. A drug survival analysis showed no statistically significant difference between the drug survival of first-line biologic agents, but ustekinumab had the highest survival rate among second-line biologics (log-rank p = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274–2.782, p = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534–3.552, p < 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 –3.780, p = 0.001) are predictors for discontinuation. Conclusion: Discontinuation of treatment was most commonly due to inefficacy. Patients who switched to a different biologic agent showed a similar improvement in PASI scores compared to biologic-naive patients. Switching to a second biologic therapy due to inefficacy or adverse events caused by the first one may improve psoriasis.研究背景与目的：本研究旨在为银屑病患者生物制剂治疗中的用药选择、换药原因及治疗结局提供循证依据。 方法：本研究于2007年1月至2019年5月期间，对6家银屑病专科三级转诊中心的患者数据开展回顾性数据库检索，分析了该登记系统中所有患者的人口学特征与治疗特征。 结果：本研究共纳入427例接受生物制剂治疗的银屑病患者，其中145例（34%）需更换为另一种生物制剂。停用首种生物制剂的原因依次为疗效不佳（n=106，62.4%）、不良事件（n=28，16.5%）及其他原因（n=36，21.2%）。治疗第12周时，接受首剂生物制剂治疗的患者的银屑病面积与严重性指数（Psoriasis Area and Severity Index, PASI）评分较基线降低67.7%，接受第二种生物制剂治疗的患者则降低51.4%。药物生存分析显示，一线生物制剂的药物留存率无统计学差异，但乌司奴单抗（ustekinumab）在二线生物制剂中留存率最高（log-rank检验p=0.010）。针对整体停药风险的多因素分析显示，合并银屑病关节炎（比值比[OR]:1.883，95%置信区间[CI]:1.274–2.782，p=0.001）、甲部受累（OR:2.334，95%CI:1.534–3.552，p<0.001）及伴随治疗（OR:2.303，95%CI:1.403–3.780，p=0.001）是停药的独立预测因素。 结论：银屑病患者停用生物制剂最常见的原因为疗效不佳。更换为其他生物制剂的患者，其PASI评分改善程度与未接受过生物制剂治疗的初治患者相近。因首种生物制剂疗效不佳或发生不良事件而更换为第二种生物制剂治疗，可有效改善银屑病病情。