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.