Issues of switching therapy when effect of biological genetically engineered drugs escapes

Abstract

The escape effect or secondary ineffectiveness of genetically engineered bio-drugs GEBD determines the change in patient management tactics, including switching to another genetically engineered drug. In clinical practice, this is a rather difficult task, which primarily concerns the choice of the next drug. The solution to the problem of secondary inefficiency can be achieved, for example, by switching to a GIBP with a different mechanism of action. In the VOYAGE 1, 73% of patients who did not respond to 48 weeks of adalimumab therapy achieved a PASI response of 90 by the 100th weeks after switching to guselkumab therapy. In the VOYAGE 2 study, 75 and 43% of patients achieved PASI 90 and 100 at week 100 after switching to gumelkumab therapy from adalimumab with failure at 28 weeks. In the NAVIGATE study, the increase in efficacy in patients with an insufficient response to ustekinumab when switching to guselcumab therapy was 27% (p < 0.001) when assessing the proportion of patients who achieved PASI 90 by 52nd weeks of therapy. Thus, the data of clinical trials make it possible to recommend guselkumab as the drug of choice in the case of the “escape” effect or insufficient effectiveness of GEBDs of other classes. The experience of using guselkumab in real clinical practice has shown its high efficiency in patients with the «escape effect» of anti-TNF-α and anti-IL‑17 drugs.