Real-World Registry Data Identify Predictors of Biologic Switching in Psoriasis Care
Patients with psoriasis who fail to achieve treatment goals on biologic therapy often benefit from switching agents, but identifying when a switch is likely to occur remains challenging. A new analysis from the CorEvitas Psoriasis Registry highlights baseline clinical and patient-reported features associated with switching biologic therapies in real-world practice, offering insights to support earlier, shared decision-making.
Investigators conducted a retrospective analysis of the prospective, multicenter, noninterventional PPD CorEvitas Psoriasis Registry. The study evaluated sociodemographics, comorbidities, disease activity, treatment patterns, and patient-reported outcomes at baseline and follow-up visits. Patients were categorized as switchers or non-switchers at each follow up, and 3 analytic approaches—logistic regression, random forest modeling, and decision tree analysis—were used to identify factors associated with switching.
Across 14,729 follow-up visits, 995 episodes (6.8%) involved a switch from 1 biologic therapy to another. In logistic regression models, higher baseline body surface area (BSA) involvement, worsening or insufficient improvement in BSA from baseline to follow up, and the addition of at least 1 nonbiologic systemic therapy were significantly associated with switching. These same factors emerged as key drivers in random forest analyses, alongside patient-reported fatigue and quality-of-life measures.
Decision tree modeling further refined risk stratification. Investigators identified 4 patient subgroups characterized by moderate-to-severe baseline BSA involvement combined with specific clinical or patient-reported features, each associated with a greater than 50% likelihood of switching biologic therapy.
The authors concluded that “identification and recognition of these features and combinations thereof can facilitate shared decision-making between clinicians and patients,” emphasizing the importance of integrating objective disease measures with patient-reported outcomes. They noted that recognizing these patterns may help clinicians anticipate dissatisfaction or inadequate response before prolonged persistence on suboptimal therapy.
For dermatologists, the key takeaway is that biologic switching is often preceded by identifiable signals, particularly residual disease burden, need for adjunctive systemic therapy, and patient-reported fatigue or impaired quality of life. Proactively addressing these factors may allow for more timely treatment adjustments, improving both clinical outcomes and patient satisfaction in long-term psoriasis management.
Reference
Austin AM, Henderson SC, Trujillo NC, et al. Features associated with therapy switch among PPD CorEvitas psoriasis registry patients. Dermatol Ther (Heidelb). Published online January 19, 2026. doi:10.1007/s13555-025-01646-1
