Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Feb 13;17(2):e78954.
doi: 10.7759/cureus.78954. eCollection 2025 Feb.

Intra-Class Interleukin-(IL)-17 Blocker Switching: Ixekizumab as a Solution for Secukinumab Non-responders in Secondary Biologic Failure in Psoriasis

Abhishek De  1 , Disha Chakraborty  2 , Sk Shahriar Ahmed  1
Affiliations
Case Reports

Intra-Class Interleukin-(IL)-17 Blocker Switching: Ixekizumab as a Solution for Secukinumab Non-responders in Secondary Biologic Failure in Psoriasis

Abhishek De et al. Cureus. .

Abstract

Monoclonal antibodies, particularly interleukin-17 (IL-17) inhibitors like secukinumab and ixekizumab, have significantly advanced the treatment of severe plaque psoriasis. Clinical guidelines suggest changing biologic classes after primary treatment failure and consider switching within the same class or to a different class for secondary failures. Secondary failure was defined as the loss of response (PASI > 50% of initial value) in a patient who had previously achieved PASI 50 response at weeks 12-16. We present a case series of five male patients with chronic plaque psoriasis, each with disease durations of 9 to 16 years. When initially treated with secukinumab (300 mg weekly for five weeks, then monthly), all patients achieved Psoriasis Area and Severity Index (PASI 90) within 4 to 12 weeks. However, they experienced secondary loss of response after 9 to 16 months, qualifying as secondary biologic failure. We then switched to ixekizumab, starting with 160 mg, followed by 80 mg every two weeks for three months, and then monthly. Significant clinical improvement was observed within two weeks of starting ixekizumab, with all patients achieving and maintaining near-clear skin (PASI 90) by six months, without significant adverse effects. This approach is particularly relevant in regions with high latent tuberculosis prevalence where TNF-alpha inhibitors are less viable. Further research is needed to confirm these results in larger cohorts.

Keywords: biologic treatment; drug resistance; il-17 blockers; ixekizumab; psoriasis treatment.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The change in the PASI score with every follow-up
PASI: Psoriasis Area and Severity Index
Figure 2
Figure 2. Multiple psoriatic plaques with erythema and scaling over the trunk, before starting ixekizumab
Figure 3
Figure 3. Clinical improvement in psoriasis along with PASI 100 in the same patient during the fourth month of treatment with ixekizumab
PASI: Psoriasis Area and Severity Index
See this image and copyright information in PMC

References

    1. Biologics and biosimilars in psoriasis. Ahmed SS, De A, Das S, Manchanda Y. Indian J Dermatol. 2023;68:282–295. - PMC - PubMed
    1. Apremilast coadministered with secukinumab for safe and effective control of psoriasis with resultant reduction of maintenance dose of the biologic. De A, Das S, Dhoot D, Sarda A. Indian J Dermatol. 2019;64:239–241. - PMC - PubMed
    1. A case of cutaneous t-cell lymphoma, masquerading as psoriasis, was given etanercept and secukinumab: emphasizing the need for biopsy confirmation before starting biologics. De A, Raychaudhury T, Rajagopalan M, Sarda A, Sharma N. Indian J Dermatol. 2017;62:533–535. - PMC - PubMed
    1. A joint consensus of rheumatologists and dermatologists on early detection and effective management of psoriatic arthritis: India's perspective. Chatterjee M, Nayak C, De A, et al. Indian J Dermatol. 2022;67:479. - PMC - PubMed
    1. Systemic management of psoriasis patients in Indian scenario: an expert consensus. Rajagopalan M, Chatterjee M, De A, et al. Indian Dermatol Online J. 2021;12:674–682. - PMC - PubMed

Publication types

LinkOut - more resources