随着治疗银屑病的生物制剂的不断发展，一些患者已经实现了最佳控制，但如果生物制剂未能最初改善皮肤（称为原发性无反应），或在初步改善后失去疗效（称为继发性无反应），则推荐的生物制剂顺序是还是缺乏。任何类别的生物制剂都可能发生原发性和继发性无反应，并且无反应的类型可以决定是在生物制剂类别内切换还是切换到不同的生物制剂类别。在治疗银屑病和并发银屑病关节炎时，生物制剂的选择也可能具有挑战性，因为治疗方法根据两种疾病的严重程度以及中轴和外周关节受累的进一步分类而有所不同。选择生物制剂时，还会考虑每位患者的合并症和偏好，以提供最佳治疗。由于生物失败后缺乏既定的生物序列，我们审查的目的是确定肿瘤坏死因子 (TNF)、白细胞介素 17 (IL-17) 和白细胞介素 23 (IL-23) 的治疗序列治疗银屑病和银屑病关节炎的抑制剂类。我们提出的生物序列是通过分析每个生物类别的功效、临床试验的主要和次要无反应率以及专家意见的临床经验得出的。© 2024。作者，获得 Springer Nature Switzerland AG 的独家许可。

With the continued development of biologics for the treatment of psoriasis, some patients have achieved optimal control, but a recommended biologic sequence if a biologic fails to initially improve the skin, termed primary nonresponse, or loses efficacy after initial improvement, termed secondary nonresponse, is still lacking. Primary and secondary nonresponse can occur with any class of biologics, and the type of nonresponse can drive the choice of whether to switch within a biologic class or to a different biologic class. The choice of biologic can also be challenging when managing psoriasis and concomitant psoriatic arthritis, as treatment differs on the basis of the severity of both diseases and further classification of axial and peripheral joint involvement. When choosing a biologic, each patient's comorbidities and preferences are also taken into account to provide the optimal therapy. With this lack of an established biologic sequence after biologic failure, the objective of our review is to define a therapy sequence for the tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitor classes in the treatment of psoriasis and psoriatic arthritis. Our proposed biologic sequence was derived through an analysis of the efficacy of each biologic class, primary and secondary nonresponse rates from clinical trials, and clinical experience with expert opinion.© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.