The therapeutic landscape of moderate-to-severe plaque psoriasis has been transformed by interleukin-17 (IL-17) and interleukin-23 (IL-23) inhibitors, which offer superior effectiveness compared to older biologics. However, a substantial proportion of patients experience primary or secondary treatment failure, necessitating a therapeutic switching.
Areas covered
This review integrates real-world evidence from studies identified through a PubMed search for publications on sequencing and switching between IL-17 and IL-23 inhibitors in plaque psoriasis. The most relevant studies were selected, and their clinical outcomes were evaluated to provide an overview of current evidence on switching strategies.
Expert opinion
Key findings indicate that interclass switching (between IL-17 and IL-23 pathways) generally outperforms intraclass switching, with IL-23 inhibitors demonstrating robust effectiveness after IL-17 failure and vice versa. Safety profiles are favorable across all switching scenarios. Future directions include biomarker-guided selection and precision medicine approaches to optimize first-line therapy choice and subsequent sequencing.
