OBJECTIVES: Chronic psoriasis often requires medication adjustments, including switches between different biologic treatments. This review evaluated clinical trial evidence on treatment switching in psoriasis.

METHODS: A targeted literature review was conducted on clinical trials from the past decade in which participants with chronic psoriasis (≥12-year-olds) were switched between biologics in the following treatment categories: oral to injectable, injectable to oral, and injectable to injectable. Switching terminology was used to ensure that articles with the correct trial design were identified.

RESULTS: Thirteen research articles encompassing 15 trials were analysed. Three trials focused on switching from a biologic reference product to a biosimilar, with comparable outcomes. In the remaining trials (n=12), participants were all switched (n=2), re-randomized depending on severity scores (n=5), or switched for having an inadequate response (n=5). Participants consistently benefited from switching between different biologics at final follow-up cut-off, which differed between trials. Participants with PASI<75 achieved PASI≥75 when switched from etanercept to ixekizumab (77.6%) or tildrakizumab (53.8%). Participants with PASI<90 achieved PASI≥90 when ustekinumab, adalimumab and secukinumab were switched to bimekizumab (90.0%, 91.0% and 79.0%, respectively), or when adalimumab was switched to guselkumab (66.1%). Switching adalimumab to risankizumab increased the proportion with PASI≥90 (21.0% vs 66.0%), as did switching ustekinumab to guselkumab (24.0% vs 50.0%), a fumaric acid ester to guselkumab (50.0% vs 80.0%), and a phosphodiesterase 4 inhibitor (apremilast) to risankizumab (2.6% vs 72.3%). Switching between biologics improved Dermatology Life Quality Index scores when reported (n=9). No switching-related safety concerns were identified.

CONCLUSIONS: Switching biologic treatments can enhance psoriasis disease control, but it is unclear if this is because of desensitization to the initial treatment or the introduction of newer, more effective treatments. To address this research gap, studies that swap between parallel treatment arms should be conducted to determine the most effective treatment strategy.