JAMA Dermatol

Interclass biologic switching in psoriasis may improve outcomes but also raises infection concerns

August 11, 2025

Study details: A systematic review and meta-analysis of 24 randomized trials (N = 12,661) evaluated the effectiveness and safety of interclass biologic switching in adult patients with plaque psoriasis. Primary outcome: PASI 90; Secondary outcomes: PASI 75/100 and adverse events.

Results: Switching biologics significantly improved PASI scores:

• Week 4 vs. baseline PASI 90: odds ratio (OR), 6.53
• Overall PASI 90: OR, 28.61
• PASI 75: OR, 11.11
• PASI 100: OR, 18.76

Safety outcomes were comparable across timepoints, with no significant differences in serious, severe, or treatment-related AEs. Infection risk was highest when switching from anti–TNF-α to anti–IL-23p19 (0.62%), anti–IL-17A (0.54%), or anti–IL-12/23p40 (0.39%).

Clinical impact: Biologic switching may benefit patients with inadequate response or biologic fatigue. Clinicians should consider infection risk when selecting switch strategies and monitor accordingly.

Source:

Zhang M, et al. (2025, August 6). JAMA Dermatol. Biopharmaceutical Switching in Psoriasis Treatment: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/40768223/