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L.L.A. Lecluse, M. De Groot, J.D. Bos, P.I. Spuls, Experience with biologics for psoriasis in daily practice: switching is worth a try, British Journal of Dermatology, Volume 161, Issue 4, 1 October 2009, Pages 948–951, https://doi.org/10.1111/j.1365-2133.2009.09384.x
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Conflicts of interest: none declared.
Sir, Not all patients with psoriasis who start biological therapy are treated satisfactorily: effectiveness may be too limited, serious side‐effects may occur or treatment may be otherwise intolerable. When treatment optimization has failed or is impossible, the next step might be another biologic.
Etanercept, efalizumab, infliximab and adalimumab are registered biologics for psoriasis, although marketing authorization of efalizumab was recently suspended for safety considerations. Although the excellent phase III trial results1 2–3 appear less impressive in routine practice, the biologics have enriched the treatment armamentarium. Following high costs and often strict reimbursement criteria,4 they form the end of the therapeutic spectrum. In our experience most patients respond well to long‐term biological treatment. When a biologic fails, however, switching to another biologic is common, despite limited evidence.
Our purpose was to provide evidence on the effectiveness and tolerability of switching between biologics for psoriasis in daily practice. Also, we compared characteristics of patients continuing, stopping or switching their first biologic.
