Switching to secukinumab in difficult-to-treat psoriasis recalcitrant to methotrexate, cyclosporine and leflunomide, in a tuberculosis-endemic country.

Several biological agents have been approved for the treatment of recalcitrant psoriasis. However, there is a lack of a consensus algorithm guiding the drug selection for patients who have failed conventional drugs. In cases not improving with cyclosporine, direct switching to a biological therapy usually leads to a disease flare owing to increased production of interleukin (IL)-17A. Thus, secukinumab, a rapidly acting anti-IL-17A drug, may be ideal in such situations.