Study Finds Biologic Switching Effective, Safe Among Patients with Psoriasis

Interclass switching between biologics for psoriasis is effective among patients, according to recent findings, and there are no significant safety differences for most individuals with this inflammatory skin condition.1

These data were recently published in JAMA, and the analysis that led to these findings was authored by such investigators as Miao Zhang, MD, from the Department of Dermatology at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine in Shanghai. Zhang et al highlighted the prevalence of concerns in clinical practice related to switching between medications prior to their research. The investigators added that such concerns included immune reaction increases, heightened safety issues, and efficacy considerations.2

“There is no scientific rationale to support or refute these concerns,” Zhang and coauthors wrote.1 “Therefore, we conducted this systematic review and meta-analysis to better understand the effectiveness and safety of biologic switching on 2 levels: short-term and long-term biologic effectiveness and safety before and after switching; and effectiveness and safety of switching vs continuing the same agent.”

Analysis Design Details

The investigative team's analysis looked into a series of randomized clinical trials (RCTs) that had involved adult participants ≥18 years with plaque psoriasis who had undergone crossover or switched from a single biologic drug to another, either within the same drug class or to an alternate class.

Those involved in the analysis utilized the Embase, PubMed, and the Cochrane Library databases, with searches conducted from the databases' inceptions through January 25, 2025. The team asked 2 independent reviewers to perform the screening of RCTs as well as the necessary data extraction in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Random-effects models were implemented by Zhang and colleagues for data pooling.

Their primary pre-specified outcome was attainment among participants of a Psoriasis Area and Severity Index (PASI) 90 response. The investigative team decided that secondary measures assessed included both clinician- and patient-reported outcomes (PROMs) as well as safety profiles. The team's efficacy assessments covered PASI 75, PASI 90, and PASI 100 responses, as well as trial subjects' Investigator’s and Physician’s Global Assessment scores of 0 or 1 and their body surface area (BSA) involvement of ≤1%.

PROMs that Zhang and coauthors evaluated included subjects' Dermatology Life Quality Index scores and the Psoriasis Symptoms and Signs Diary. In terms of safety endpoints, these encompassed overall adverse events (AEs), severe AEs, serious AEs, treatment-related AEs, and specific categories of AEs.

Findings on the Efficacy of Biologic Switching

A total of 24 RCTs were evaluated, with 12,661 participants and 8 biologic-switch categories being analyzed. Overall, the investigators' systematic review and meta-analysis showed that switching between biologic classes was efficacious in a substantial proportion of those involved in these studies. Specifically, Zhang et al found that PASI 90 responses improved significantly between the 4-week mark and baseline (odds ratio [OR], 6.53; 95% CI, 2.58–16.51).1

The investigative team additionally observed substantial differences across other PASI endpoints. These included PASI 90 (OR, 28.61; 95% CI, 12.89–63.47), PASI 75 (OR, 11.11; 95% CI, 5.95–20.75), and PASI 100 (OR, 18.76; 95% CI, 8.37–42.01). Over the course of their safety analyses, no statistically significant differences were seen by the team between endpoint and baseline for serious AEs (OR, 1.63; 95% CI, 0.72–3.69), severe AEs (OR, 1.40; 95% CI, 0.61–3.26).

They also did not observe significant treatment-related AE differences (OR, 1.79; 95% CI, 0.41–7.88). The highest infection rates were noted by Zhang and colleagues when switching from anti–tumor necrosis factor-α (anti–TNF-α) drugs to anti–interleukin (IL)-17A (0.54%), anti–IL-23p19 (0.62%), or anti–IL-12/23p40 (0.39%) agents.

“This systematic review and meta-analysis found that, based on the results of 24 RCTs, interclass biologic switching was effective and there were no safety differences for most patients,” they concluded.1 “Specifically, switching from anti−TNF-α agents to anti−IL-23p19 agents and from anti−IL-12/23p40 agents to anti−IL-23p19 agents led to significantly improved effectiveness, with PASI 75, 90, and 100 demonstrating enhanced therapeutic outcomes.”

The team's data suggest that with the growing range of biologic options targeting distinct immunologic pathways, switching between classes may be a valuable—and potentially superior—approach to management of psoriasis for certain individuals. Nonetheless, Zhang et al highlighted their belief in the need for larger studies with extended follow-up.

References

1. Zhang M, Hong S, Wang Q, et al. Biopharmaceutical Switching in Psoriasis Treatment: A Systematic Review and Meta-Analysis. JAMA Dermatol. Published online August 06, 2025. doi:10.1001/jamadermatol.2025.2714.

2. Kay J, Schoels MM, Dörner T, et al; Task Force on the Use of Biosimilars to Treat Rheumatological Diseases. Consensus-based recommendations for the use of biosimilars to treat rheumatological diseases. Ann Rheum Dis. 2018;77(2):165-174. doi:10.1136/annrheumdis-2017-211937.