DISCUSSION
Psoriasis is a chronic disease that can vary substantially among affected individuals in terms of severity, areas involved, and response to treatments. Consequently, patients may need to undergo multiple drug trials to find the treatment regimen that best addresses their needs. While primary failure of biologic drugs is a substantial challenge, so too is the loss of treatment response over time. This complicates the achievement of longterm control of psoriasis, which is an important outcome for many patients. For instance, in a survey eliciting treatment goals in 500 patients with psoriasis, 94% reported that long-term maintenance of clear skin (ie, 2-3 years) was highly important.35
When a patient experiences treatment failure with a biologic therapy, some clinicians advocate switching to a drug with a different mechanism. With each biologic failure, treatment options narrow. In a complex treatment landscape where patients may undergo treatment with multiple biologics, clinicians must consider the interactions between different drug mechanisms to recommend the optimal therapy.31 In this regard, brodalumab, which has a unique mechanism that inhibits the receptor of the central cytokine implicated in psoriasis pathogenesis, is promising; brodalumab not only has a broader effect on downstream inflammatory pathways, but it also overcomes the loss of response to IL-17 inhibitors. This concept is supported by several studies showing that substantial proportions of patients achieve PASI goals after switching from secukinumab or ixekizumab to brodalumab.24 Evidence also supports the efficacy of brodalumab after failure of other common biologics such as ustekinumab and adalimumab, as well as after the use of multiple biologics.31
Patients with prior biologic failure or loss of response are a subset of individuals with psoriasis who most likely have a more severe disease with a greater impact on quality of life. It is important to determine therapeutic approaches that will help these patients long-term, as psoriasis can have multifaceted physical effects and psychosocial consequences. Additionally, switching between multiple biologics is associated with clinical
When a patient experiences treatment failure with a biologic therapy, some clinicians advocate switching to a drug with a different mechanism. With each biologic failure, treatment options narrow. In a complex treatment landscape where patients may undergo treatment with multiple biologics, clinicians must consider the interactions between different drug mechanisms to recommend the optimal therapy.31 In this regard, brodalumab, which has a unique mechanism that inhibits the receptor of the central cytokine implicated in psoriasis pathogenesis, is promising; brodalumab not only has a broader effect on downstream inflammatory pathways, but it also overcomes the loss of response to IL-17 inhibitors. This concept is supported by several studies showing that substantial proportions of patients achieve PASI goals after switching from secukinumab or ixekizumab to brodalumab.24 Evidence also supports the efficacy of brodalumab after failure of other common biologics such as ustekinumab and adalimumab, as well as after the use of multiple biologics.31
Patients with prior biologic failure or loss of response are a subset of individuals with psoriasis who most likely have a more severe disease with a greater impact on quality of life. It is important to determine therapeutic approaches that will help these patients long-term, as psoriasis can have multifaceted physical effects and psychosocial consequences. Additionally, switching between multiple biologics is associated with clinical
