Dose tapering in psoriasis is associated with a low relapse rate

Among investigated psoriasis patients receiving biologics, 88% remained in sustained clinical response after 8 months of dose tapering. The low relapse rate, together with remarkable cost savings, supports this approach as an effective strategy for treating psoriasis.

Biologic therapy results in long-term low disease activity or even clinical remission in patients with moderate-to-severe psoriasis; the downside is the high costs. Dr Juan Raul Castro Ayarza (Medicarte, Colombia) and his team performed a cohort study to investigate whether optimisation of treatment by a progressive dose reduction or increase of the administration interval can still prevent relapses in these patients [1].

Patients presenting with psoriasis to a specialised, multicentre health institution in Colombia who were above 18 years of age and treated with biologic therapy with a sustained response for at least 12 months were included. They were treated with different biological agents, including anti-TNFs, ustekinumab, secukinumab, ixekizumab, guselkumab, and risankizumab. Optimisation strategy was achieved either by dose reduction or interval administration increase. Of the 467 patients, 12.2% (n=57) met the optimisation strategy criteria. The majority were men (65%) with a median age of 57 years and a duration of psoriasis of 15 years. They were receiving treatment for 4 years, and the dose tapering was done over 8 months. In 85.8% of patients, the tapering strategy was performed by an increase in the application interval and the remaining 14.2% by dose reduction. Among the patients undergoing the optimisation strategy, 16.4% (n=14/85) received ustekinumab, 14% (n=20/142) adalimumab, 12.6% (n=9/71) secukinumab, 12.3% (n=8/65) ixekizumab, 10% (n=3/30) etanercept, and 7.5% (n=3/40) guselkumab. Psoriasis Area and Severity Index (PASI) >10 was defined as a relapse, and Kaplan-Meier estimates were used to calculate the relapse rate by biologic therapy.

Overall, only 12% (7 out of 57) of patients relapsed, and the incidence rate was 2.2 person-months (95% CI 0.97–4.4). No significant differences in relapse rates according to the type of medication were detected. As such, 88% of patients in the tapering strategy remained in sustained clinical response after 8 months.

1. Castro-Ayarza JR, et al. Biological therapy optimisation (dose tapering) strategy in patients with psoriasis in a specialised health center in Colombia. DP17, SPIN 2022 Congress, 06–08 July, Paris, France.

 

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Posted on 26 August 2022