Shany Sherman, Efrat Solomon Cohen, Iris Amitay-Laish, Emmilia Hodak, Lev Pavlovsky
DOI: 10.2340/00015555-3200

Interleukin-17A inhibitors are a promising alternative to tumor necrosis factor-α inhibitors for the treatment of psoriasis. In-class switch has been hardly investigated for interleukin-17A inhibitors. We report the experience (2017–2018) of a tertiary medical center with interleukin-17A-inhibitor switch in patients with moderate-to-severe psoriasis. Patient-, disease- and outcome-related data were retrospectively collected from the electronic files of 25 patients switched to ixekizumab following secukinumab failure. Mean ± standard deviation patient age was 56.7 ± 12.2 years. Mean baseline Psoriasis Area and Severity Index was 25. Secukinumab was discontinued due to primary failure in 7 patients and secondary failure in 18. Ixekizumab was administered for 7.3 ± 2.8 months; 22 patients were still on ixekizumab at the end of the study. Mean ± standard deviation Psoriasis Area and Severity Index reduction from baseline at study end was 75.5±20.0%. Patients with moderate-to-severe psoriasis seem to be amenable to treatment with ixekizumab following secukinumab failure. Further large multicenter studies are needed.

The limited arsenal of biologic treatments available for moderate-to-severe psoriasis may make IL-17A in-class switch (secukinumab-to-ixekizumab) necessary, following a primary or secondary failure. Patients with heavily pretreated moderate-to-severe psoriasis respond well to ixekizumab for a relatively long time. The number of previous lines of treatment may adversely affect ixekizumab efficacy.