ABSTRACT
IL-23 inhibitors are a class of injectable biologics consisting of risankizumab, tildrakizumab, and guselkumab utilized for treatment of moderate-to-severe psoriasis. This retrospective review sought to determine the value of IL-23 inhibitor intraclass switching among psoriasis patients after experiencing loss of efficacy to any IL-23 inhibitor. We conducted a retrospective chart review, including 43 patients who underwent any of six potential iterations of IL-23 intraclass switch between 11/2017-11/2023. Most commonly, patients switched from guselkumab or tildrakizumab to risankizumab (83.7%). Patients failed 2.3 ± 1.3 biologic treatments prior to switch. Post-switching, 81.4% of patients achieved BSA <1% after 248.8 ± 126.5 days. BSA immediately prior to intraclass switch was 13.1 ± 8.9 [95% CI: 10.4, 15.8] and at most recent follow-up was 2.9 ± 5.2 [2.3, 5.5]. This research adds to a growing body of literature demonstrating the potential of IL-23 intraclass switching in treatment of moderate-to-severe plaque psoriasis.
ABSTRACT
Biologics and Janus kinase (JAK) inhibitors are immunomodulating and immunosuppressing medications utilized to treat atopic dermatitis (AD), psoriasis (PSO), psoriatic arthritis (PsA), and alopecia areata (AA). Special recommendations must be considered when prescribing vaccinations in this population, as the pneumococcal and herpes zoster vaccine are recommended to patients ≥ 19-years-old (rather than ≥ 65-years-old and ≥ 50-years-old as in the general population, respectively), along with a yearly influenza and up to date COVID-19 vaccination. Additionally, TNF-α and JAK-inhibitors may increase the risk of latent Hepatitis B virus (HBV) reactivation among high-risk patients. Prior to prescribing these medications, a quantitative HepB Surface Antibody (HepB SA) test is performed to determine immunity. This study utilized the SlicerDicer function on EPIC Medical Records to search for any patient ≥ 19-years-old prescribed a biologic or JAK inhibitor for AD, PSO, PsA, or AA between 10/2003 and 10/2023 at a large tertiary institution. Vaccination rates among patients on biologics and JAK inhibitors were low, with rates being significantly lower in patients 19-64 years-old, compared to those ≥ 65 years-old for most disease states (p < 0.01). Among AD, PSO/PsA, and AA patients, on average, 9.39% were vaccinated for influenza, 6.76% for herpes zoster, 16.56% for pneumococcal pneumonia, and 63.98% for COVID-19. Only 3.16% of patients were adequately vaccinated for HepB after an abnormal HepB SA test. Here, extremely low rates of vaccination among patients on biologics and JAK inhibitors at our institution were highlighted, emphasizing the imperative need for ensuring vaccination in this group.