Criteria used to define tumor necrosis factor-alpha inhibitors failure in patients with moderate-to-severe psoriasis: a systematic literature review

Background: Determining tumor necrosis factor-alpha inhibitors (anti-TNF-alpha) failure is still a challenge in the management of moderate-to-severe psoriasis. Thus, our comprehensive systematic literature review aimed to gather information on the criteria used to define anti-TNF-alpha failure. We also aimed to discover the main reasons for anti-TNF-alpha failure and define subsequently administered treatments. Materials and methods: We conducted a systematic review following review and reporting guidelines (Cochrane and PRISMA). International (Medline/PubMed and Cochrane Library) and Spanish databases (MEDES, IBECS), and gray literature were consulted to identify publications issued until April 2021 in English or Spanish. Results: Our search yielded 58 publications. Of these, 37 (63.8%) described the criteria used to define anti-TNF-alpha primary or secondary failure. Criteria varied across studies, although around 60% considered Psoriasis Area and Severity Index (PASI)-50 criteria. Nineteen (32.8%) reported the reasons for treatment failure, including the lack or loss of efficacy and safety-related problems, mainly infections. Finally, 29 (50%) publications outlined the treatments administered after anti-TNF-alpha: 62.5% reported a switch to another anti-TNF-alpha and 37.5% to interleukin (IL)-inhibitors. Conclusion: Our findings suggest a need to standardize the management of anti-TNF-alpha failure and reflect the incorporation of new targets, such as IL-inhibitors, in the treatment sequence.

Automated summary

This comprehensive systematic literature review aimed to gather information on the criteria used to define anti-TNF-alpha failure in the management of psoriasis. The study found that the criteria varied across studies, with the main reasons for treatment failure being lack or loss of efficacy and safety-related problems. The review also outlined the subsequent treatments administered, including switching to other anti-TNF-alpha drugs and using IL-inhibitors.