Dermatology diseases need the highest doses of biologics

When comparing different biologic agents and their regimens for various inflammatory conditions, it appeared that patients with dermatologic diseases require the highest doses for loading and maintenance. For the treatment of psoriasis, the use of loading doses provided short-term but no long-term benefits.

Reasons for prescribing loading doses in biologic treatment are various, including aiming for a faster clinical response and to quickly achieve therapeutic drug levels and disease control at the beginning of treatment [1,2]. Dr Charlotte Greif (Beth Israel Deaconess Medical Center, MA, USA) and her colleagues reviewed 254 studies that compared biologic treatment for psoriasis and other inflammatory diseases, such as rheumatic diseases or inflammatory bowel disease, concerning the advantages of loading doses [1]. Only 5 of those studies included head-to-head assessment of loading doses, with direct comparison data for adalimumab, etanercept, and secukinumab. To evaluate different regimens, maximum dosages over the induction phase (weeks 1–12) and the maintenance period (weeks 13–34) were calculated for each agent and diagnosis. This resulted in a possibility of overall discrimination between high-dose and low-dose treatments.

In general, the systemic review showed higher loading and maintenance dosing in patients treated for dermatologic conditions compared with other inflammatory diseases. This difference was seen for both treatment phases (i.e. induction and maintenance), with the highest quantity of drug administration in patients with hidradenitis suppurativa. The higher dosing in dermatologic diseases could be due to the extension of the involved surface, especially in obese patients.

For psoriasis, the different studies revealed that patients can benefit in the short term when loading doses are administered, leading to faster ameliorations with, for example, greater reductions in Psoriasis Area and Severity Index (PASI). However, this advantage does not seem to be reflected in the long-term efficacy of the treatment. Thus, the value of loading doses may be speed to improvement rather than the overall success rate.

1. 
   
   1. Greif C, et al. Do loading doses in systemic therapy for psoriasis improve clinical outcomes? P33121, AAD 2022 Annual Meeting, 25–29 March, Boston, MA, USA.
   2. Geurts-Voerman GE, et al. BMC Rheumatol. 2020 Jul 28;4:37.

 

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Posted on 17 May, 202215 February, 2024