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. 2023 Sep;37(9):1848-1853.
doi: 10.1111/jdv.19135. Epub 2023 May 4.

Efficacy of anti-IL-23 and anti-IL-17 after adalimumab failure in psoriatic patients

L Mastorino  1 , S Susca  1 , C Cariti  1 , N Sliquini  1 , A Verrone  1 , E Stroppiana  1 , M Ortoncelli  1 , P Dapavo  1 , S Ribero  1 , P Quaglino  1
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Efficacy of anti-IL-23 and anti-IL-17 after adalimumab failure in psoriatic patients

L Mastorino et al. J Eur Acad Dermatol Venereol. 2023 Sep.

Abstract

Background: Many national guidelines at the European level recommend first-line therapy based on the anti-TNF-alpha adalimumab for treatment of psoriasis and psoriatic arthritis, mainly for economic reasons. Consequently, patients being treated with newer IL-17 and IL-23 inhibitors underwent previous unsuccessful first-line adalimumab-based therapy.

Objectives: Evaluate the efficacy and safety of IL-17 and IL-23 inhibitors after treatment with adalimumab compared to adalimumab-naive psoriatic patients.

Methods: We retrospectively analysed 1053 psoriatic patients treated with anti-IL17 and anti-IL23 agents, which included 68 and 24 adalimumab-experienced and 399 and 260 bio-naive patients. Efficacy was assessed with mean PASI, PASI90, PASI100, and <3.

Results: Concerning the achieving of PASI100, PASI90 and PASI < 3 in patients treated with anti-IL17 agents, no significant differences were observed between adalimumab-experienced and bio-naive patients. In patients treated with an anti-IL-23 agent, a faster response was observed in bio-naive patients, with PASI < 3 significantly higher than ADA-experienced patients at 16 weeks (77% vs. 58% p = 0.048). In a sub-analysis that evaluated the performance of anti-IL17 and anti-IL23 agents in adalimumab-experienced patients with a history of secondary failure, no significant differences were found. In multivariate analysis of PASI100, only anti-IL-17 therapy appeared to have a negative impact at 52 weeks (OR: 0.54 p = 0.04) independently of previous treatment. For PASI90, type of treatment and bio-naïve status did not seem to have an impact at any time point.

Conclusions: Anti-IL 23 and anti-IL 17 agents are not significantly different in terms of efficacy in bio-naive patients or as second-line therapy after failure with a biosimilar or originator adalimumab.

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References

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