INTRODUCTION
Unfortunately, clinical trials all must end and in doing so, any benefits that may have been achieved by the study subject volunteering for the clinical trial may be lost, especially in clinical trials for psoriasis where chronic disease has a higher recurrence rate when removing effective therapy. Occasionally, long remission rates are seen in some patients, but this is unpredictable and variable. Some patients, whether in a clinical trial or not, experience primary failure (lack of initial efficacy). These patients usually drop out of clinical trials or are withdrawn as per protocol. Some patients experience secondary failure (loss of efficacy with time) that may require dose optimization, adjunctive therapy, or transition to or sequencing to another biologic in the same or different class of the original biologic.
Rarely, however, does transitioning or sequencing to another biologic occur when there is no failure of the original biologic the patient is taking and a change in biologic is “forced†upon the patient for other reasons. One of these reasons may be lack of availability of the biologic that the patient is taking. This lack could be due to manufacturing difficulties, safety reasons, affordability, insurance issues, or personal choice. This change in biologic from the original (old) biologic to the new biologic, whether in the same class or not, may not achieve the same result or provide similar satisfaction to the patient. However, choosing another safe and effective biologic for the transition is key to patient satisfaction, continued clinical improvement and quality of life.
It is well documented that there is considerable variation in responses between patients. There is also variation between treatments when using biologics in patients with moderate to severe psoriasis. This variation reflects the clinical and genetic heterogeneity of psoriasis and genetic polymorphisms in drug metabolism and response.1 Although IL-17 blockers act upon the IL-17 pathway, these biologics have distinguished characteristics with respect to structure, mechanism of action, pharmacokinetics, and pharmacodynamics. This may give a variable response rate. However, the factors of above can’t explain why one IL-17 blocker that fails may not preclude the effectiveness of another IL-17 blocker. This case series does not concern itself with the failure of one and transition to another but the exact opposite. These are successful cases of response to one biologic (brodalumab) transitioning to another biologic in the same class with continued improvement (secukinumab).
METHODS
A retrospective chart review of 11 patients with moderate to severe plaque psoriasis who were previously enrolled in a clinical trial with brodalumab was carried out. No data from the clinical trial were obtained nor will be presented in order to maintain confidentiality. All patients were seen in regular follow-up shortly after the trial was discontinued when the sponsor decided not to continue product development for psoriasis in Canada and United States. Discussion with the
