Outcomes Linked to Psoriasis Biologic Switches

What outcomes are you most acutely monitoring for when a patient must switch biologics?

Brad Glick, DO, FAAD: We want to look first that patients that switch from one agent to another have a successful response with a low-event profile or no event profile. Many of the clinical trials, and I think this speaks to all the questions that you've asked me in a way if we want to discuss some clinical trial data, there are a number of clinical trials, for instance, from the Voyage 1 and Voyage 2 trials, where we have an aging like you geselkumab, which is compared to adalimumab. We have patients that are in the clinical trial that may not be completely reaching the benchmark for the trial, which is, for instance, a PASI 90 or clear a minimal disease. And when they cross over, those individuals, even those that were having reasonably successful responses, are able to reach high responses or higher responses when shifted over to a more targeted therapy like an interleukin 23 blocker such as geselkumab.

And we see this in a number of clinical trials. It's helpful information from a practical sense, because if someone's doing well on a product like adalimumab, then we keep them on therapy. But if they're not performing well, and they have to shift over, we've learned from the clinical trial data that patients can achieve even higher level responses, with very representable safety profiles comparable to a drug like the market leader in adalimumab.

And so we really have been able to extract a lot of this very helpful information for use in the trenches where I practice. And there are many examples. And most of the modern-day clinical trials have comparateur arms, and so we're able to see how patients who will perform, they may have done an older agent, let's pick one like interleukin 12, 23 inhibitor, and doing well for quite some time and they may get somewhat of a loss of response or for whatever reason they had to go off of therapy, let's say for a surgery, they try to go back on therapy, they don't achieve the responses that they have had previously. We have clinical trial data that indicates that patients that crossover from some of the older agents that we have into some of the newer, more highly effective agents like the interleukin 17 and 23 blockers, that they could have highly successful responses, psoriasis area and severity index responses of 90 or 100. In high percentages of patients when they cross over from older agents to some of the newer agents as we see in clinical trials, as I just referenced a couple moments ago.