Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study

Background: Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched. Objective: We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival. Methods: In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan–Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival. Results: Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P =.0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0 years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P =.014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P =.003, hazard ratio 0.48). Limitations: As a single-center, retrospective real-life study, the data were not perfectly homogeneous. Conclusion: Switching between biologic classes might increase drug survival but retrospective studies designed ad hoc are needed to confirm this better switching strategy.