Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: results from the Italian Psocare registry

J Am Acad Dermatol. 2014 Feb;70(2):257-62.e3. doi: 10.1016/j.jaad.2013.10.019. Epub 2013 Dec 16.


Background: Some studies have shown that switching patients from one tumor necrosis factor (TNF)-alfa inhibitor to another may be beneficial when they have an inadequate response or an adverse event.

Objective: We sought to assess the variables predicting the efficacy of the second TNF-alfa inhibitor in patients discontinuing the first TNF-alfa inhibitor.

Methods: Data from all 5423 consecutive patients starting TNF-alfa inhibitor therapy for psoriasis between September 2005 and September 2010 who were included in the Italian Psocare registry were analyzed.

Results: In 105 patients who switched to a second TNF-alfa inhibitor who had complete follow-up data, 75% improvement in the Psoriasis Area Severity Index score (PASI 75) was reached by 29% after 16 weeks and by 45.6% after 24 weeks. Patients who switched because of secondary loss of efficacy (loss of initial PASI 75 response) or adverse events/intolerance were more likely to reach PASI 75 than those who switched as a result of primary inefficacy (PASI 75 never achieved) (hazard ratio 2.7, 95% confidence interval 1.3-5.5 vs hazard ratio 2.0, 95% confidence interval 1.0-3.9 and 1, respectively).

Limitations: There was a small number of patients with complete follow-up data.

Conclusion: PASI 75 response in patients who switched from one anti-TNF-alfa agent to another was significantly reduced in patients who showed primary inefficacy of the first anti-TNF-alfa.

Keywords: 75% improvement in the Psoriasis Area Severity Index score; PASI; PASI 75; Psoriasis Area Severity Index; TNF; biologics; efficacy; primary inefficacy; psoriasis; secondary loss of efficacy; switching; tumor necrosis factor; tumor necrosis factor-alfa inhibitors.

Publication types

  • Comparative Study

MeSH terms

  • Adalimumab
  • Adult
  • Analysis of Variance
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Cohort Studies
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Etanercept
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / administration & dosage*
  • Infliximab
  • Italy
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Receptors, Tumor Necrosis Factor / administration & dosage*
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / therapeutic use
  • Young Adult


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Etanercept