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

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.