Switching Biologics in Psoriasis Boosts Effectiveness but Raises Infection Risk

Patients with psoriasis found that switching between classes of biologic therapies can deliver faster short-term and more stable long-term effectiveness, especially when transitioning to anti–IL-23p19 agents, according to a new study.1 However, the analysis also revealed a higher risk of infection, particularly when switching from anti–tumor necrosis factor (TNF)-α agents.

This systematic review and meta-analysis study is published in JAMA Dermatology.

A systematic review finds interclass biologic switching improves outcomes but also increases infection rates. | Image Credit: Shutter2U - stock.adobe.com

“The findings of our study confirmed that interclass biologic switching improves short-term effectiveness and stabilizes long-term effectiveness without compromising safety,” wrote the researchers. “We found no significant differences in effectiveness or safety between patients who switched biologics and those who continued the same treatment.”

A growing body of evidence suggests that strategic switching—whether between biologic classes for clinical benefit or to lower-cost biosimilars—can offer both health and economic advantages for patients with plaque psoriasis.2 Biologic therapy costs more than doubled from 2007 to 2021, rising from $21,236 to $47,125 annually, despite the emergence of biosimilars and lower-cost alternatives. As newer, high-priced agents gain popularity, incorporating biosimilar switching into treatment planning could help curb escalating spending while maintaining strong clinical outcomes.

This study aimed to assess the effectiveness and safety of interclass biologic switching in adults with plaque psoriasis.1 PubMed, Embase, and the Cochrane Library were searched from database inception through January 25, 2025, for randomized clinical trials involving patients aged 18 years or older who switched from one biologic agent to another, either within the same class or to a different class. Two independent reviewers screened studies, extracted data, and assessed study quality in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data were pooled using random-effects models to evaluate primary and secondary outcomes, including Psoriasis Area and Severity Index (PASI) responses, clinician- and patient-reported measures, and safety endpoints such as adverse events and infection rates.

The analysis included data from 24 randomized clinical trials encompassing 12,661 patients. The findings revealed that interclass biologic switching in psoriasis treatment led to significantly improved effectiveness, with faster short-term responses and more stable long-term outcomes compared with continued therapy on the initial agent.

Compared with baseline, switching led to substantial gains in PASI responses, including 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). Short-term effectiveness was also observed, with PASI 90 rates improving as early as week 4 (OR, 6.53; 95% CI, 2.58-16.51). The most notable benefits occurred when switching from anti–TNF-α or anti–IL-12/23p40 agents to anti–IL-23p19 agents.

Although safety outcomes such as serious adverse events (OR, 1.63; 95% CI, 0.72-3.69) and severe adverse events (OR, 1.40; 95% CI, 0.61-3.26) did not differ significantly from baseline, infection risk was higher when moving from anti–TNF-α agents to anti–IL-23p19 (0.62%), anti–IL-17A (0.54%), or anti–IL-12/23p40 agents (0.39%).

However, the researchers noted limitations to the study, including heterogeneity of clinical trial designs and relatively short trial periods. Additionally, variations in definitions of adverse events and infection monitoring could have influenced safety estimates. Finally, the analysis was restricted to published randomized controlled trial data, which may not fully capture outcomes seen in broader, more diverse patient populations.

Despite these limitations, the researchers believe the findings underscore both the therapeutic potential and safety considerations of biologic switching in adult patients with psoriasis.

“However, further confirmatory data from larger patient cohorts and longer follow-up periods are required to obtain more conclusive results,” wrote the researchers. “Our results highlight the importance of vigilance for infections when switching biologics.”

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. Steinzor P. Rising costs of biologics for plaque psoriasis highlight savings potential. AJMC®. April 24, 2025. Accessed August 11, 2025. https://www.ajmc.com/view/rising-costs-of-biologics-for-plaque-psoriasis-highlight-savings-potential