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Induction Period for Switching Biologics in Psoriasis Recommended

Patients with moderate-to-severe psoriasis who switch biologic medications at the end of a clinical trial should go through an induction period.

By Whitney L. Jackson

Patients with moderate-to-severe psoriasis who switch biologic medications at the end of a clinical trial should go through an induction period, according to the results of a new study.

An August 2016 study published in the Journal of Drugs in Dermatology found, unless safety is a concern, patients should undergo an induction regimen without a washout period to maintain drug efficacy.

Led by Ronald B. Vender, MD, director of Dermatrials Research, Inc., this retrospective chart review of 11 patients looked at the impact of switching from brodalumab, a human monoclonal IgG2 antibody that targets IL-17 receptors to inhibit IL-17 cytokine binding, to secukinumab, a recombinant, high-affinity, fully human monoclonal anti-human IL-17A antibody of IgG1/kappa isotope, at the end of a clinical trial.

Before the clinical trial, all patients were naïve to brodalumab, using only topical steroids previously. At the time of study, secukinumab was the only other appropriate biologic available in both the United States and Canada.

“Most transitioning of biologics occurs during a period of either primary or secondary failure of another biologic,” researchers wrote. “This case series provided a unique opportunity to retrospectively present 11 patients transitioning when they were actually clear or almost clear.”

Participants experienced co-morbidities, including hypertension, Type 2 diabetes, psoriatic arthritis, depression and high cholesterol, at two-to-six weeks post-clinical trial termination. And, all received a loading dose of secukinumab four-to-eight weeks after their last brodalumab dose. Afterwards, they received 30-mg, subcutaneous secukinumab doses at weeks 0, 1, 2, 3, and 4, as well as a 300-mg monthly dose thereafter.

At six-month follow-up, patients were all clear or almost clear of their psoriasis. This result supports the assertion that induction regimens are helpful in maintaining drug effectiveness when transitioning between biologic medications without a washout period.

The study was limited, researchers said, by the small number of patients and the short, six-month follow-up period. Investigations were also limited because clinical trial data about patient-specific responses to brodalumab was confidential.



Ronald B. Vender, MD, FR, CPC. “Transitioning Between Brodamulab and Secukinumb in Moderate to Severe Psoriasis: An Early Look,” Journal of Drugs in Dermatology. Published August 2016. 15(8): 941-943.