Sequencing and switching among IL-17 and IL-23 biologics in plaque psoriasis: real-world lessons and precision strategies for the future.

INTRODUCTION

The therapeutic landscape of moderate-to-severe plaque psoriasis has been transformed by interleukin-17 (IL-17) and interleukin-23 (IL-23) inhibitors, which offer superior effectiveness compared to older biologics. However, a substantial proportion of patients experience primary or secondary treatment failure, necessitating a therapeutic switching.

AREAS COVERED: This review integrates real-world evidence from studies identified through a PubMed search for publications on sequencing and switching between IL-17 and IL-23 inhibitors in plaque psoriasis. The most relevant studies were selected, and their clinical outcomes were evaluated to provide an overview of current evidence on switching strategies.

EXPERT OPINION: Key findings indicate that interclass switching (between IL-17 and IL-23 pathways) generally outperforms intraclass switching, with IL-23 inhibitors demonstrating robust effectiveness after IL-17 failure and vice versa. Safety profiles are favorable across all switching scenarios. Future directions include biomarker-guided selection and precision medicine approaches to optimize first-line therapy choice and subsequent sequencing.