Psoriasis — SCE Dermatology MCQ

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HardDermatopharmacologyPsoriasisSCE Dermatology

A 48-year-old man with plaque psoriasis on Infliximab for 3 years develops new anti-drug antibodies (ADAs) with reduced clinical response. What is the most appropriate management strategy?

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Correct answer: D — Switch to a biologic of a different class

Development of anti-drug antibodies (ADAs) to anti-TNF biologics (particularly Infliximab, which is a chimeric antibody with higher immunogenicity than fully human antibodies) can lead to reduced drug levels, loss of efficacy, and infusion reactions. When significant ADAs develop with clinical failure, the recommended approach is to switch to a biologic of a different class (e.g., IL-17 or IL-23 inhibitor) rather than another anti-TNF, as cross-class switching is more likely to achieve a response than within-class switching. Adding Methotrexate can reduce ADA formation prophylactically but is less effective once significant ADAs have developed.

Reference: BAD 2020 Biologic Psoriasis Guidelines; BJD 2018 Drug Levels