Switching to IL-17 inhibitors achieves 73.5% PASI-75 in psoriasis patients failing IL-23 therapy

For patients with moderate-to-severe psoriasis, biologic therapies targeting specific inflammatory pathways have revolutionized treatment. However, a significant challenge remains for patients who experience inadequate response or loss of efficacy to initial biologics. Specifically, data on effective treatment strategies after failure of IL-23 inhibitors, a class of biologics that targets the p19 subunit of interleukin-23 to block its signaling, are limited. Understanding the efficacy and drug survival of alternative biologic classes, such as IL-17 inhibitors (e.g., secukinumab, ixekizumab, bimekizumab), in this specific patient population is crucial for optimizing long-term disease management and improving patient outcomes.

Researchers conducted a retrospective analysis using the BIOREP registry, spanning from January 2015 to June 2025. The study identified 102 patients with psoriasis who transitioned from an IL-23 inhibitor to an IL-17 inhibitor due to insufficient efficacy. The primary endpoints were PASI-75 (Psoriasis Area and Severity Index reduction of 75%) and absolute PASI ≤ 1 at 3 and 12 months post-switch. Drug survival rates were also assessed at 12 and 24 months. The analysis focused on real-world outcomes in patients who had at least one follow-up visit recorded after the switch.

Of the 102 patients who switched from an IL-23 inhibitor to an IL-17 inhibitor, 92 (90.2%) did so due to insufficient prior efficacy. In this cohort of 92 patients, significant improvements were observed: > PASI-75 was achieved by 82.6% of patients after 3 months and 73.5% after 12 months of IL-17 inhibitor therapy. Absolute PASI ≤ 1 was reached by 66.3% of patients at 3 months and 52.9% at 12 months. Among the IL-17 inhibitors, bimekizumab demonstrated the highest probability of achieving both efficacy parameters, particularly absolute PASI ≤ 1 at 3 months. The overall drug survival probability for IL-17 inhibitors was robust, standing at 79.5% after 12 months and 68.1% after 24 months.