Real‐World Effectiveness and Safety of Biologic Switches in Chinese Patients With Plaque Psoriasis: A Single‐Center Retrospective Study

Objective This study assesses the real‐world effectiveness and safety of biologic switching in plaque psoriasis, addressing the complexity of biologic therapies and the variability in optimal switching strategies to inform clinical decision‐making. Methods This single‐center retrospective study included adult patients with plaque psoriasis (> 18 years old) who received treatment with tumor necrosis factor‐α (TNF‐α) inhibitors, interleukin (IL)‐17 inhibitors, IL‐23 inhibitors, or IL‐12/23 inhibitors between January 2020 and November 2024. Baseline characteristics and data on treatment duration, treatment strategy, and severity of skin lesions were recorded. Patients were categorized into six groups based on their biologic switching strategies. Kaplan–Meier estimates and Cox regression analysis were employed to evaluate drug retention rates and associated factors. Results This study included 1144 patients (mean age: 44.29 years, 69.41% male) with an average biologic treatment duration of 20.5 months. IL‐17 inhibitors were the most commonly used (61.1%), followed by IL‐12/23 inhibitors (7.2%) and TNF‐α inhibitors (4.9%). Among 114 patients who switched biologics, 128 switches occurred, most frequently from IL‐17 to IL‐23 inhibitors (30.5%), followed by intraclass IL‐17 switches (27.3%). Kaplan–Meier analysis showed higher early dropout rates for IL‐17 to IL‐12/23 switches, while TNF‐α to IL‐17 switches had a marked retention decline after 600 days. Cox regression identified age and BMI as significant factors, with older age and lower BMI linked to higher retention. Notably, switching from IL‐17 to IL‐12/23 inhibitors significantly improved retention rates. Conclusion Biologic switching is common in plaque psoriasis treatment, mainly due to inadequate initial efficacy. IL‐17 inhibitors are favored for their rapid and potent effects, but switching to IL‐12/23 or IL‐23 inhibitors can restore clinical response when needed. Patient factors, including age and BMI, significantly influence switching outcomes. Larger multicenter studies are required to validate these findings and assess long‐term impacts.