Interleukin 12/23 inhibitors (IL-12/23i) and interleukin 17 and 23 inhibitors (IL-17i and IL-23i) represent the drug classes with the most favorable expectations for therapeutic response. However, the introduction of biosimilars has led many centers, for reasons of efficiency, to prioritize tumor necrosis factor inhibitors (TNFi) as first-line therapy. Data on whether prior exposure to TNFi may affect the drug survival of IL-17i and IL-23i therapies are lacking.

Using data from the Biobadaderm registry, we compared treatment persistence among patients with psoriasis who received IL-17i or IL-23i as first-line therapy and those who received these agents after prior TNFi treatment. Rates of treatment discontinuation and adverse events (AEs) were compared between groups.

Results showed that overall drug survival was higher in patients treated first line with IL-17i or IL-23i vs those treated after TNFi exposure. However, no significant differences were observed between groups in treatment discontinuation due to inefficacy or serious AEs. Overall AE rates were similar, with no differences in serious AEs or serious infections. Although global AE rates and discontinuation due to AEs were higher in patients previously on TNFi who subsequently received IL-17i or IL-23i vs biologic-naïve patients, these differences did not reach statistical significance.

In conclusion, this study suggests that prior exposure to TNFi may influence the persistence of IL-17i and IL-23i therapies in patients with psoriasis.