5PSQ-074 Sequential monoclonal antibody therapy in psoriasis management: evaluating clinical outcomes and treatment durability

<h3>Background and Importance</h3> Psoriasis is a chronic inflammatory skin disorder. Monoclonal antibodies (mAbs) have revolutionised psoriasis treatment. Some patients experience suboptimal responses or adverse events, necessitating treatment modifications. Switching mAbs offers a therapeutic strategy to address these challenges. <h3>Aim and Objectives</h3> Evaluation of the efficacy, safety, and persistence of mAb switching in psoriasis treatment based on real-world clinical practice in a tertiary hospital <h3>Material and Methods</h3> A retrospective observational study was conducted, including all psoriasis patients who switched from one mAb to another from January 2017 to December 2023. The following data were collected: patient demographics (sex, age), initial disease characteristics (Psoriasis Area and Severity Index – PASI), duration of initial mAb treatment, reasons for switching, efficacy outcomes (PASI score, PASI 75 and PASI 90), and adverse events. Statistical analysis comprised descriptive analysis of all variables, followed by comparison tests to evaluate significant differences before and after mAb switching. <h3>Results</h3> The study included 124 psoriasis patients (61% male), with a median age of 55 years (range: 18–102 years). The median initial PASI score was 22 (interquartile range -IQR-: 14–35 points). The median duration of initial mAb treatment was 15 months (IQR: 7–23 months). Initially used mAbs were adalimumab (49.6%), ustekinumab (37.6%), secukinumab (9.6%), and guselkumab (3.2%). The most common reasons for mAb switching were loss of efficacy (67%), lack of response (18%), and adverse effects (15%). The median reduction in PASI score after switching mAbs was 62% (IQR: 14–73%). After mAb switching, 82% of patients achieved a PASI 75 response, and 57% achieved a PASI 90 response. The median duration of treatment after mAb switching was 13 months (IQR: 5–21 months). 20.2% of patients required two or more mAb switches due to lack of response (96%) or intolerance (4%) to previous mAbs. <h3>Conclusion and Relevance</h3> Switching between monoclonal antibodies represents a viable option for treating psoriasis patients with inadequate response or intolerance to initial treatment. The results suggest that switching can provide significant clinical benefits, with acceptable safety and good long-term treatment persistence. The efficacy of mAb switching is supported by significant improvements in PASI and DLQI scores. Safety profiles after mAb switching are generally favourable, with no unexpected safety signals identified. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest