Transitioning Between Biologics

Main Article Content

Ronald Vender MD FRCPC


Psoriasis, Biologics, Switching, Changing, Transitioning


Background: Transitioning between biologics has become an important part of practice.

Objective: Patients with moderate to severe plaque psoriasis who are on biologics can have efficacy failures, as well as safety concerns. This would often necessitate a change of biologic, which may be within the same class or to a different class. A change due to an adverse event from the presently used biologic may resolve or require treatment until a new biologic is introduced, which may pose some delay in the initiation of the subsequent biologic. 

Methods: A review of the literature and guidelines published were performed. 

Results: A practical guide to transitioning between biologics are presented

Limitations: There are no randomized placebo-controlled trials to determine the best method of transitioning between biologics.

Conclusion: Transitioning between biologics is an option for those patients requiring such a change either for safety or efficacy reasons.


1. Mrowietz U, Kragballe K, Reich K, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res. 2010;303(1):1-10.

2. Gladman D, Poulin Y, Adams K, Treating Psoriasis and Psoriatic Arthritis: Position Paper on Applying the Treat-to-target Concept to Canadian Daily Practice The Journal of Rheumatology Apr 2017, 44 (4) 519-534

3. Piaserico, Stefano et al. Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: Results from the Italian Psocare Registry Journal of the American Academy of Dermatology , 2014 Volume 70 Issue 2 , 257 - 262.e3

4. Mrowietz, U. , Steinz, K. and Gerdes, S., Psoriasis: to treat or to manage?.2014 Exp Dermatol, 23: 705-709. doi:10.1111/exd.12437

5. Gulliver, W., Lynde, C., Dutz, J. et al.. Think beyond the Skin: 2014 Canadian Expert Opinion Paper on Treating to Target in Plaque Psoriasis. Journal of Cutaneous Medicine and Surgery, 2015 19(1), 22–27.

6. Mrowietz, U. , de Jong, E. , Kragballe, K. , et al., A consensus report on appropriate treatment optimization and transitioning in the management of moderate‐to‐severe plaque psoriasis. 2014 J Eur Acad Dermatol Venereol, 28: 438-453.

7. Smith, C. , Jabbar‐Lopez, Z. , Yiu, Z. , et. al British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol, 177: 628-636.

8. Dunbar-Jacob, J. et al., Treatment adherence in chronic disease Journal of Clinical Epidemiology , Volume 54 , Issue 12 , S57 - S60

9. Ahluwalia, V., Rampakakis, E., Movahedi, M. et al. Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative Clin Rheumatol (2017) 36: 2421.

10. Cather JC, Crowley JJ. Use of biologic agents in combination with other therapies for the treatment of psoriasis. Am J Clin Dermatol. 2014;15(6):467-78.

11. Choi, Young M. et al. From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology ,2016 Volume 75 , Issue 4 , 798 - 805.e7

12. Mrowietz U, Kragballe K, Reich , et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus J Eur Acad Dermatol Venereol 2011; 25 Suppl 3: 1–13.

13. Downs, A. (2010), Observational case series on a group of patients with severe psoriasis who failed to respond to antitumour necrosis factor α biologics and switched to ustekinumab. British Journal of Dermatology, 163: 433-434.

14. Puig Spanish Evidence-Based Guidelines on the Treatment of Psoriasis With Biologic Agents, 2013. Part 1: On Efficacy and Choice of Treatment Actas Dermo-Sifiliográficas (English Edition) Volume 104, Issue 8, October 2013, Pages 694-709

15. Menter A, Strober B, Kaplan D et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology , 2019 Volume 80 , Issue 4 , 1029 - 1072
16. National Institute for Health and Care Excellence, NICE Guidelines, Oct 2012-Updated Dec 2017- Sec Psoriasis: assessment and management
17. Leman, J. and Burden, A, Sequential use of biologics in the treatment of moderate‐to‐severe plaque psoriasis. British Journal of Dermatology,2012, 167: (Suppl 3)12-20.

18. Vender R JDD Transitioning Between Brodalumab and Secukinumab in Moderate to Severe Psoriasis: An Early Look August 2016 Vol 15(8) pp941-43)

19. Georgakopoulos JR Phung M, Ighani, A, et al., Efficacy and safety of switching to ixekizumab in secukinumab nonresponders with plaque psoriasis: A multicenter retrospective study of interleukin 17A antagonist therapies JAAD July 2018 79(1) pp 155-57

20. Gasslitter, I Kirsten, N., Augustin, M. et al. Successful intra-class switching among IL-17 antagonists: a multicentre, multinational, retrospective study.Arch Dermatol Res (2019).

21. Langley, R. , Tsai, T. , Flavin, S. , (2018), Efficacy and safety of guselkumab in patients with psoriasis who have an inadequate response to ustekinumab: results of the randomized, double‐blind, phase III NAVIGATE trial. Br J Dermatol, 178: 114-123.
22. Clinical Response Following Re-Treatment with a Selective IL-23p19 Inhibitor Risankizumab (BI 655066) or Switching from Ustekinumab to Risankizumab in Patients with Moderate-to-Severe Chronic Plaque Psoriasis;Papp K, et al. (FC03.04; Oral Session; Thursday, September 29, 2016; 1:45-1:55 p.m. CET).

23. Hu, Y., Chen, Z., Gong, Y. et al. A Review of Switching Biologic Agents in the Treatment of Moderate-to-Severe Plaque Psoriasis Clin Drug Investig (2018) 38: 191.