Psoriasis patients who are less responsive to biologic treatments: Switch or combine?

Almost 25% of patients do not show a satisfactory response to biologic treatments. Therapy has to be terminated in some case due to adverse events or loss of efficacy. We present two patients with recalcitrant psoriasis and psoriatic arthritis that presented a therapeutic challenge. The therapeutic options are reviewed, such as switching to a new biologic treatment, combination of a biologic with a traditional systemic treatment, or systemic treatment with an immunomodulating agent not registered for psoriasis.