Systematic review of efficacy of anti-tumor necrosis factor (TNF) therapy in patients with psoriasis previously treated with a different anti-TNF agent

J Am Acad Dermatol. 2016 Sep;75(3):612-618.e6. doi: 10.1016/j.jaad.2016.02.1221. Epub 2016 Apr 6.


Background: Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure).

Objective: We sought to systematically investigate the efficacy and safety of a second TNF antagonist after failure of a first TNF antagonist.

Methods: Published primary studies evaluating the efficacy of switching TNF antagonists after failure were systematically extracted.

Results: Fifteen studies were included. Although response rates to a second TNF antagonist were lower than for a first, a substantial proportion of patients in every study achieved treatment success. Week-24 response rates for a second antagonist were 30% to 74% for a 75% improvement in Psoriasis Area and Severity Index score and 20% to 70% for achieving a Physician Global Assessment score of 0/1; mean improvements in Dermatology Life Quality Index ranged from -3.5 to -13. In general, patients who experienced secondary failure achieved better responses than patients with primary failure. Adverse event incidences ranged from 20% to 71%, without unexpected adverse events; 0% to 11% of patients experienced serious adverse events.

Limitations: There was no common definition of treatment failure across these studies of varied design.

Conclusions: Some patients benefit from switching to a second TNF antagonist after failure of a first TNF antagonist, with improved quality of life.

Keywords: adalimumab; etanercept; failure; infliximab; psoriasis; switching; tumor necrosis factor antagonist.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adalimumab / therapeutic use
  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Drug Substitution / methods*
  • Etanercept / therapeutic use
  • Female
  • Humans
  • Infliximab / therapeutic use
  • Male
  • Middle Aged
  • Prognosis
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Failure
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / therapeutic use


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