Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(4):6010 1 Brodalumab Efficacy in Psoriasis Patients with Inadequate Response to IL-23 or IL-12/23 Inhibitors: Multicenter Italian Retrospective Analysis - IL PSO (Italian Landscape Psoriasis) Diego Orsini1,2, Maria Concetta Fargnoli2, Martina Burlando3, 4, Anna Campanati5, Elena Campione6, Claudio Guarneri7, Alessandra Narcisi8, Paolo Pella9, Paolo Romita10, Massimo Travaglini11, Leonardo Zichichi12, Luisa Maria Halina Arancio13, Chiara Assorgi25, Ginevra Baggini14, Riccardo Balestri15, Luca Bianchi6, Alexandra Maria Giovanna Brunasso16, Anna Elisabetta Cagni17, Giacomo Caldarola18,19, Gianluca Calianno10, Antonio Carpentieri11, Martino Carriero20, Andrea Carugno21, Franco Cona22, Antonio Costanzo8, Emanuele Cozzani3, 4, Giacomo Dal Bello23, Paolo Dapavo42, Annunziata Dattola25, Antonio Di Tano7, Federico Diotallevi5, Marianna Donnarumma26, Elena De Col 27, Maria Esposito28, Carmen Silvia Fiorella29, Marco Galluzzo6, Francesca Graziola30, Giovanni Carlo Lazzaro Danzuso24, Matteo Licciardello31, Agostina Legori32, Viviana Lora2, Piergiorgio Malagoli33, Matteo Megna34, Federica Mola35, Gaia Moretta36, Andrea Muracchioli37, Attilia Musumeci38, Maria Letizia Musumeci39, Gianluca Pagnanelli36, Vincenzo Panasiti40, Eugenio Provenzano41, Simone Ribero42, Daniele Rizzo12, Marco Rubatto46, Oriele Sarno43, Davide Strippoli44, Fabrizio Vaira45, Dario Graceffa2 1 Departmental Faculty of Medicine, UniCamillus - “Saint Camillus International University of Health and Medical Sciences”, Rome, Italy 2 San Gallicano Dermatological Institute (IRCCS), Rome, Italy 3 Section of Dermatology, Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy 4 IRCCS San Martino University Hospital, Genoa, Italy 5 Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy 6 Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy 7 Department of Biomedical and Dental Sciences and Morpho Functional Imaging, Section of Dermatology, University of Messina, Italy 8 Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy 9 Dermatology Unit, Ospedale degli Infermi, Biella, Italy 10 Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari “Aldo Moro”, Bari, Italy 11 U.O.S.D. Dermatologica - Centro per la cura della psoriasi, Ospedale A. Perrino, Brindisi, Italy 12 Dermatology Unit, Ospedale S A Antonio Abate, ASP Trapani, 91016, Erice, Italy 13 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano; ASST Crema, Italy 14 Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, Italy 15 Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, Italy 16 Department of Internal Medicine-Dermatology, Villa Scassi Hospital, ASL3, Genoa, Italy 17 Unità Operativa Dipartimentale di Dermatologia e Venereologia, IRCCS San Gerardo, Milan, Italy 18 Dermatology Unit, Agostino Gemelli University Polyclinic Foundation, IRCCS, Rome, Italy 19 Section of Dermatology, Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy 20 Dermatology Outpatient, ASL Taranto, Italy 2 Original Article | Dermatol Pract Concept. 2025;15(4):6010 21 Dermatology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy 22 Umberto I, City Hospital of Enna, Enna, Italy 23 Section of Dermatology, Department of Medicine, ASST di Mantova, Mantova, Italy 24 U.O.S.D Dermatologia, A.O. ‘S.Elia’ - Caltanissetta, Caltanissetta, Italy 25 Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy 26 Dermatology Unit, “Andrea Tortora” Hospital, ASL Salerno, Pagani, Italy 27 Unit of Dermatology, Civil Hospital of Imperia, Imperia, Italy 28 Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy 29 Division of Dermatology, “Mons. Dimiccoli” Hospital, Barletta, Italy 30 Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, Italy 31 Section of Dermatology, Koelliker Hospital, Turin, Italy 32 UO Dermatologia IRCCS Ospedale Galeazzi & Università degli Studi di Milano, Milan, Italy 33 Department of Dermatology, Dermatology Unit Azienda Ospedaliera San Donato Milanese, 20097 Milan, Italy 34 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy 35 Dermatology Unit, ASST Lariana, Como, Italy 36 Department of Dermatology, Istituto Dermopatico dell’Immacolata IRCCS Roma, Roma, Italy 37 Unit of Dermatology, San Bartolomeo Hospital, La Spezia, Italy 38 UOSD Dermatologia, ARNAS Garibaldi, Catania, Italy 39 UOC Dermatologia, University of Catania, PO “G. Rodolico”, AOU Policlinico “G. Rodolico-San Marco”, Catania, Italy 40 Fondazione Policlinico Universitario Campus Bio Medico, Rome, Italy 41 Dermatology Unit, Azienda Ospedaliera di Cosenza, Cosenza, Italy 42 Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy 43 Department of Dermatology and Dermosurgery, AOSG San Giuseppe Moscati, Avellino, Italy 44 Dermatology Unit, Manzoni Hospital, ASST-Lecco, Lecco, Italy 45 Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy 46 Candiolo Cancer Institute, FPO—IRCCS, Candiolo, Italy Key words: Brodalumab, Psoriasis, Comorbidity, IL-7 inhibitors, IL-23 inhibitors, Switch Citation: Orsini D, Fargnoli MC, Burlando M, et al. Brodalumab effectiveness on psoriasis patients who failed anti-interleukin 23 or 12/23: a multicenter, retrospective study – IL PSO (Italian Landscape Psoriasis). Dermatol Pract Concept. 2025;15(4):6010. DOI: https://doi .org/10.5826/dpc.1504a6010 Accepted: March 6, 2025; Published: October 2025 Copyright: ©2025 Orsini et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: D. Orsini has been a speaker and/or consultant for Abbvie, LeoPharma, UCB, Bristol-Meyer-Squibb, and Boehringer Ingelheim. R. Balestri has received support for attending meetings and/or travel from AbbVie, Amgen, Leo Pharma, Lilly, Novartis, and Sanofi. M. Burlando acted as a speaker or consultant for Abbvie, Eli Lilly, Janssen, Leo-Pharma, UCB, Novartis, Bristol-Meyer-Squibb, and Boehringer Ingelheim. G. Caldarola has received honoraria as speaker and consultant for Abbvie, Almirall, Biogen, Eli Lilly, LEO Pharma, Novartis, Janssen, Sanofi, Pfizer, and UCB Pharma outside the submitted work. A. Campanati has served as a speaker, consultant, or advisory board member for Abbvie, Almirall, Amgen, Eli-Lilly, Leo Pharma, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, Boehringer Ingelheim, and UCB Pharma. E. Campione has served as advisory board member, received fees for lectures, and/or research grants by Almirall, Amgen, Abbvie, Bristol Myers Squibb, Incyte, Leo Pharma, and UCB. A. Carugno has been a speaker and/or consultant for Almirall, Amgen, Abbvie, Boehringer Ingelheim, Eli Lilly, Leo Pharma, Janssen-Cilag, Novartis, and UCB Pharma. A. Costanzo has been a consultant and/or speaker for AbbVie, Almirall, Amgen, Janssen, Leo Pharma, Eli Lilly, Galderma, Boehringer, Novartis, Pfizer, Sandoz, and UCB. E. Cozzani acted as a speaker or consultant for Abbvie, Almirall, Eli Lilly, Leo-Pharma, and Novartis. G. Dal Bello has been a consultant for Abbvie, Eli Lilly, Janssen, Sanofi, UCB, and Novartis. A. Dattola has served as a speaker, consultant, or advisory board member for Abbvie, Almirall, Amgen, Eli Lilly, Leo Pharma, Janssen, Novartis, Boehringer Ingelheim, and UCB Pharma outside the submitted work. M. Esposito has served as speaker/consultant for Abbvie, Amgen, Almirall, Eli Lilly, Janssen, Leopharma, Novartis, Pfizer, Sanofi, and UCB. M.C. Fargnoli has served on advisory boards, received honoraria for lectures and/or research grants from AMGEN, Almirall, Abbvie, Boehringer-Ingelheim, BMS, Galderma, Kyowa Kyrin, Incyte, LEO Pharma, Pierre Fabre, UCB, Lilly, Pfizer, Janssen, MSD, Novartis, Sanofi, Regeneron, and Sun Pharma. C. Guarneri has received consultation fees and/or grants for research projects, advisory panels, and giving educational lectures from Wyeth-Pfizer, Abbott Immunology-Abbvie, Janssen-Cilag, Novartis, LEO-Pharma, LEO- Pharma Denmark, Ely-Lilly, Celgene, Merck-Serono, UCB Pharma, Sanofi-Aventis, Amgen, and Almirall. P. Malagoli has been a speaker for AbbVie, Lilly, Novartis, Janssen-Cilag, Celgene, Leopharma, and Almirall. A. Narcisi has served on advisory boards, received honoraria for lectures and research grants from Almirall, AbbVie, BMS, Leo Pharma, Celgene, Eli Lilly, Janssen, Novartis, Sanofi-Genzyme, Amgen, and Boehringer Ingelheim. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Diego Orsini MD, PhD. Clinical Dermatology Unit, San Gallicano Dermatological Institute (IRCCS), Via Elio Chianesi, 52, 00144 Roma (RM). E-mail: diego.orsini@ifo.it Original Article | Dermatol Pract Concept. 2025;15(4):6010 3 Introduction The recent worldwide deployment of anti-interleukin (IL)-17 and anti-IL-23 drugs has revolutionized the treatment para- digm of psoriatic disease, allowing a dramatic improvement in the rate of achievement and maintenance of clinical remis- sion [1, 2]. However, regardless of psoriasis forms and the disease domains involved, a variable percentage of patients still ex- perience primary therapeutic failure, incomplete response, or progressive loss of treatment efficacy (secondary therapeutic failure). In this context, switching treatments among dif- ferent mechanisms of action has been explored in previous studies conducted on psoriatic patients [3-5]. However, criteria providing a clear clinical rationale for such transitions are lacking, and no clear guidance is pro- vided by international guidelines to date. Considering that most patients treated with anti-IL drugs have previously experienced failure of at least one traditional DMARDs and in some cases even one or more biologics, the most obvious and widely used strategy to manage this difficult subgroup of patients is to attempt an interclass switch from an anti-IL-23 to an anti-IL-17 and vice versa. Brodalumab is the only monoclonal antibody directed toward the IL-17 recep- tor A. Because of this peculiar mechanism of action, broda- lumab could block IL-17A, IL-17F, IL-17A/F, and IL-17E isotypes, providing deeper cytokine inhibition and faster anti- inflammatory activity than other drugs of the same class [6]. Results from the AMAGINE 1-2-3 randomized con- trolled trials (RCTs) showed that 51% of patients achieved complete skin clearance (PASI 100) after 52 weeks of treatment. Efficacy was sustained over a long period, with more than half of patients maintaining PASI 100 and more than 75% of patients maintaining almost clear skin (PASI 90) up to 120 weeks [7-9]. Objectives We performed a real-life retrospective study to evaluate the safety and the efficacy of brodalumab in a subgroup of pso- riasis patients who already failed anti-IL23 or anti-IL12/23 treatment. Patients and Methods We retrospectively evaluated over a follow-up period of 52 weeks a cohort of 23 psoriasis patients who underwent a medical switch to brodalumab exclusively following primary or secondary therapeutic failure of anti-IL-23 or anti-12/23 drugs. Patients who transitioned for adverse effects or be- cause of any reason other than anti-IL23 or anti-12/23 fail- ure were excluded from the study. Clinical and quality-of-life parameters collected at baseline (start of brodalumab treat- ment) and at four predefined timepoints (4, 16, 36, 52 weeks of continuous brodalumab treatment) were included for the purposes of this study. The following parameters were used for statistical comparisons: Psoriasi Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), presence/ absence of active psoriatic arthritis, presence/absence of ad- verse events. Data were summarized by means of descrip- tive analysis. Means and standard deviations (SDs) were Introduction: The use of brodalumab in patients with psoriasis who have failed other biologic drugs is an underexplored topic. Objectives: To evaluate the safety and the efficacy of brodalumab in a subgroup of psoriasis patients who already failed anti-IL23 or anti-IL12/23 treatment. Methods: Using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), we retrospectively evaluated a cohort of 23 patients with psoriasis who underwent a change in therapy with brodalumab exclusively following primary or secondary therapeutic failure of an- ti-IL-23 or anti-12/23 drugs. Results: The mean PASI decreased significantly following the introduction of brodalumab after four weeks of treatment, continuing to decrease at 16 and 36 weeks, reaching the nadir at 52 weeks (base- line PASI baseline: 14.6 ± 9.2 vs. 52 weeks PASI: 1.1 ± 1.8; P<0.001). Sixty-three point six percent of patients reached PASI 100 just after 16 weeks. The same trend of improvement was also observed for the DLQI. The adverse effects observed in our study population were generally mild. Conclusions: Our results are in line with the current literature and suggest that patients who have failed therapy with IL-23 or IL-12/23 inhibitors may benefit from switching to brodalumab, which could be considered a good choice for patients who need a rapid resolution of the inflammatory skin condition. ABSTRACT 4 Original Article | Dermatol Pract Concept. 2025;15(4):6010 remaining were overweight or obese (mean BMI= 28.8 ± 5.9). The mean PASI at baseline was 14.4 ± 9.1, and 100% of participants had at least one difficult-to-treat area involved. Almost 13% (3/23) of patients had been diagnosed with oligoarticular psoriatic arthritis (PsA) yet were in complete and stable remission at the time of brodalumab prescription. Baseline demographic characteristics were summarized in Table 1. All patients involved in the study (N=23) had previously received unsuccessful treatment with traditional DMARDs and were receiving, at the time of enrollment, one of the following anti-IL-23 or 12/23 inhibitors–guselkumab, til- drakizumab, risankizumab, or ustekinumab–as their first biological treatment. Most participants (14, 60.8%) were on anti-IL23 treatment at the time of switching to broda- lumab, while nine patients (39.1%) were on ustekinumab (anti-IL12/23). Previous biological treatments used by the study population are summarized in Table 2. The mean PASI decreased significantly after the intro- duction of brodalumab as early as week 4 of treatment, from a mean value of 14.6 ± 9.2 to 6.0 ± 7.1 (P<0.001). The trend of PASI improvement persisted during follow-up assessments performed at 16 and 36 weeks, reaching the nadir at 52 weeks (PASI: 1.1 ± 1.8; P<0.001) (Table 3, Figure  1). The percentages of patients who progressively achieved the PASI 75, 90, and 100 clinical responses on as- sessments performed at the scheduled timepoints are shown in Table 4 and depicted graphically in Figure 2. Mirroring the results obtained on disease severity, the DLQI also im- proved significantly in our study population, dropping to 1/3 of the baseline level after just four weeks of treatment with brodalumab (baseline: 16.9 ± 7.6 vs. 4 weeks: 5.1 ± 7.0; P<0.001) and reaching the lowest value after 52 weeks of treatment (1.8 ± 3.8; P<0.001). The trend of the DLQI across all assessments is summarized in Table 5 and graph- ically represented in Figure 3. Of note, two patients (8.7%) calculated for continuous variables, while absolute values and frequency (%) were calculated for categorical variables. A t-test or analysis of variance was performed to compare mean values, while a paired t-test compared mean values at different timepoints. The chi-squared test was used to com- pare frequencies. The statistical significance was defined as P<0.05. All analyses were performed with IBM SPSS Statis- tics for Windows, Version 26.0. Results The mean age of the patients enrolled was 56.7 ± 13.9 years. Only 4/23 (17.4%) patients were normal weight, while the Table 1. Clinical and Demographic Characteristics of our Population at Baseline Visit. Demography N=23 Male, N (%) Age (years), mean ± SD Disease duration (years), mean ± SD BMI, mean ± SD Obese, N (%) Overweight, N (%) Normal weight, N (%) Diabetes, N (%) Hypertension, N (%) Hyperlipidemia, N (%) Thyroid disease, N (%) Cardiopathy, N (%) Other, N (%) PsA, N (%) ≥ 1 Difficult-to-treat areas, N (%) PASI baseline, mean ± SD Naïve for systemic therapies, N (%) 18 (78.3%) 56.7 (± 13.9) 20.4 (± 9.7) 28.8 (± 5.9) 7 (30.4%) 19 (82.6%) 4 (17.4%) 2 (2.9%) 10 (43.5%) 8 (34.8%) 1 (4.3%) 3 (13.0%) 3 (13.0%) 3 (13.0%) 23 (100%) 14.4 (± 9.1) 0 Table 2. Last Previous Biological Therapies. Last previous biological therapy  N=23  Reason for discontinuation Guselkumab  6 (26.1%)  primary inefficacy (1, 16.7%) loss of efficacy (5, 83.3%) Risankizumab 3 (13.0%) primary inefficacy (1, 33.3%) loss of efficacy (1, 33.3%) other (1, 33.3%) Tildrakizumab 5 (21.7%)  primary inefficacy (1, 20.0%) loss of efficacy (4, 80.0%) Ustekinumab 9 (39.1%) primary inefficacy (1, 11.1%) loss of efficacy (7, 77.8%) other (1, 11.1%) 12/23 (52.2%) patients have taken more than one previous biologic drug. Original Article | Dermatol Pract Concept. 2025;15(4):6010 5 Table 3. Mean PASI by Visit. Visit Mean PASI (SD) mPASI decrease Paired t-test Baseline (N=22) 14.6 (± 9.2) 4 weeks (N=22) 6.0 (± 7.1) -8.6 (± 6.0) <0.001 16 weeks (N=22) 2.6 (± 5.7) -11.9 (±6.8) <0.001 36 weeks (N=22) 1.7 (± 3.4) -12.9 (±6.9) <0.001 1 year (N=21) 1.1 (± 1.8) -12.0 (± 6.0) <0.001 Figure 1. mPASI by Visit. Figure 2. Relative PASI over One Year. experienced a primary non-response to brodalumab treat- ment (median PASI at baseline: 9.3 vs median PASI at 16 weeks: 7.8; P= 0.3). Both subjects discontinued therapy af- ter the assessment performed at 16 weeks of treatment and were further switched to a biologic of a different class. All three PsA patients maintained clinical remission; however, none of them underwent ultrasound assessment for subclin- ical disease detection. We found no significant difference in clinical response to brodalumab among the previous failed anti-IL23 or anti-IL12/23. None of patients included in the study experienced any major adverse effect, while 9/23 pa- tients (39.1%) reported mild adverse events mainly related to an increased susceptibility to transient rhinopharyngeal infections and oral candidiasis. Furthermore, no signifi- cant depressive symptom was reported by patients enrolled during the scheduled follow-up period.  6 Original Article | Dermatol Pract Concept. 2025;15(4):6010 16 weeks of treatment with brodalumab and in 45.5% of patients after 26 weeks [15]. As shown in Table 4, the percentage of our patients who achieved PASI 100 just after 16 weeks of treatment was 63.6%, a significantly higher proportion compared to the results obtained by Papp et al. Discussion A critical question in the clinical management of psoriasis, and particularly in the case of therapeutic failure of a biologic drug, is whether it is more appropriate to use a drug of the same class or to switch to another class. Some real-world ev- idence has shown that failure of a specific cytokine- directed treatment does not preclude the use of biologics from other classes or from the same class, making this an interesting research topic regarding the long-term management of pso- riasis [10-12]. Unfortunately, to date there is a lack of biomarkers to guide treatment changes. Therefore, intra- or interclass switching in the treatment of psoriasis is currently based on the dermatologist’s experience, the severity of the disease, the skin areas involved, and the patient’s comorbidities. In this context, real-world data supporting the availability and the rate of efficacy and safety of these treatment changes are highly needed. A recent study showed brodalumab to be one of the biologic drugs with lowest anti-drug-antibody (ADAs) formation rates. This finding supports this biologic agent as a suitable drug for patients who have experienced thera- peutic failures potentially due to the presence of ADAs [13]. A recent trial on psoriatic patients experiencing a failure of ustekinumab showed a favorable and earlier effect of broda- lumab as compared to guselkumab, thus providing import- ant information to help physicians in the choice of therapy for this subgroup of patients [14]. Recently, Papp et al. conducted an open-label study on a large cohort of patients with psoriasis that demonstrated how brodalumab can be useful in patients who do not re- spond to TNF-α, IL-12/23, or IL-17 inhibitors. These au- thors found a PASI 100 response in 40.3% of patients after Figure 3. Mean DLQI by Visit. Table 4. Percentage of Patients with PASI Score Reduction of 75, 90, and 100, by Visit. PASI 75 Visit N % 4 weeks 16 weeks 36 weeks 1 year 9/22 16/22 17/22 17/21 40.9 72.7 77.3 81.0 PASI 90 Visit N % 4 weeks 16 weeks 36 weeks 1 year 6/22 14/22 15/22 13/21 27.3 63.6 68.2 61.9 PASI 100 Visit N % 4 weeks 16 weeks 36 weeks 1 year 5/22 14/22 14/22 13/21 22.7 63.6 63.6 61.9 PASI <2 Visit N % 4 weeks 16 weeks 36 weeks 1 year 8/22 15/22 17/22 17/21 36.4 68.2 77.3 81.0 Original Article | Dermatol Pract Concept. 2025;15(4):6010 7 Ethics Approval: Institutional review board approval was exempted for this study as its procedure did not deviate from good routine clinical practice. The study was conducted in accordance with the Helsinki Declaration of 1964 and its later amendments. Consent to Participate: All patients gave written informed consent for the retrospective retrieval of anonymized data. Consent for Publication: All patients gave written informed consent for the publication of anonymized data. References 1. Egeberg A, Andersen YMF, Halling-Overgaard AS et al. Cor- rigendum: Systematic review on rapidity of onset of action for interleukin-17 and interleukin-23 inhibitors for psoriasis. J Eur Acad Dermatol Venereol. 2020 Sep;34(9):2156. DOI: 10.1111 /jdv.16827. Erratum for: J Eur Acad Dermatol Venereol. 2020 Jan;34(1):39-46. DOI: 10.1111/jdv.15920. PMID: 33448477. 2. Dapavo P, Siliquini N, Mastorino L et al. Efficacy, safety, and drug survival of IL-23, IL-17, and TNF-alpha inhibitors for pso- riasis treatment: a retrospective study. J Dermatolog Treat. 2022 Jun;33(4):2352-2357. DOI: 10.1080/09546634.2021.1961998. PMID: 34315331. 3. 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A prospective phase III, ran- domized, double-blind, placebo-controlled study of broda- lumab in patients with moderate-to-severe plaque psoriasis. Additional data on brodalumab efficacy after anti-IL 23 failure are lacking. In this context, our real-life 52-week retrospective study demonstrates good efficacy, speed of action, and safety of brodalumab in psoriasis patients with previous exposure to IL-23 and 12/23 inhibitors with per- formances similar or superior to those shown in RCTs. The excellent results obtained in our group of patients unre- sponsive to IL-23 inhibitors could be explained by a more extensive suppressive effect exerted by this drug on the Th-17 pathway. Interestingly, this feature was not asso- ciated in our study population with a higher incidence of infectious events or the occurrence of inflammatory bowel disease. Limitations of the study The main limitations of our study include its retrospective design and the relatively small number of patients involved. However, it should be noted that IL-23 inhibitors have very high response rates and a consequently limited number of treatment failures. Another limitation of our study was the inability to demonstrate whether main clinical and anamnes- tic variables could influence the therapeutic performance of brodalumab. Despite the implementation of a Cox regres- sion model, the small sample size, and high remission rate achieved in patients (only two primary failures) probably precluded us from identifying any variable that could affect the key endpoint of the study. Conclusions In conclusion, our results suggest that patients who had pre- viously failed therapy with IL-23 or IL12/23 blockers may respond to medical switch to another class of biologics. 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Br J Dermatol. 2016 Aug;175(2):273-86. DOI: 10.1111/bjd .14493. PMID: 26914406. 8. Lebwohl M, Strober B, Menter A et al. Phase 3 Studies Compar- ing Brodalumab with Ustekinumab in Psoriasis. N Engl J Med. 2015 Oct;373(14):1318-28. DOI: 10.1056/NEJMoa1503824. PMID: 26422722. 9. Papp KA, Leonardi C, Menter A et al. Brodalumab, an anti- interleukin-17-receptor antibody for psoriasis. N Engl J Med. 2012 Mar 29;366(13):1181-9. DOI: 10.1056/NEJMoa1109017. PMID: 22455412. 10. Mastorino L, Roccuzzo G, Dapavo P et al. Switching from IL23 inhibitors to IL17 inhibitors: A safe and effective practice? Der- matol Ther. 2022 Sep;35(9):e15697. DOI: 10.1111/dth.15697. PMID: 35796147; PMCID: PMC9540258. 11. Kushnir-Grinbaum D, Ziv M. Drug survival of interleukin 17 inhibitors after switch from interleukin 23 inhibitors in psoria- sis: An observational cohort study. J Am Acad Dermatol. 2024 Dec;91(6):1260-1263. DOI: 10.1016/j.jaad.2024.07.1514. PMID: 39182683.