Background Biologic drugs have demonstrated efficacy and safety in the treatment of chronic plaque psoriasis. Frequently, label doses tend to be reduced in clinical practice when a sustained response has been reached.
Purpose To assess the effectiveness and safety related to the optimisation of biological therapies in mild to moderate psoriasis (mmP) patients.
Material and methods A prospective observational study of patients with mmP receiving treatment with optimised doses of etanercept(ETA), adalimumab(ADA) or ustekinumab(UST) was conducted. Patients with response maintained for at least 6 months (defined as maintenance of at least 75% improvement in psoriasis area and severity index (PASI75) reached with standard doses) were included.
Treatment regimens, based on the frequency of dosage, were: ETA—50 mg/10 days; 50 mg/14 days; 50 mg/30 days; ADA—40 mg/21 days; 40 mg/28 days; and UST—45 mg/16 weeks; 45 mg/20 weeks. The primary effectiveness endpoint was the proportion of patients with response maintained(ie, PASI reached with standard doses) at weeks 12 and 24 after dose reduction. Secondary endpoints were proportion of patients with a maintained response distributed by drug, treatment regimen and quality of life, assessed by the Dermatology Life Quality Index(DLQI, score from 0 (no impact of skin disease on quality of life) to 30 (maximum impact)) at weeks 0 and 24. A checklist to record the main adverse reactions was developed.
Results 32 mmP patients with biological therapy optimised doses were included. At week 12, 96.8% of patients achieved a maintained response. 1 patient with ETA/10 days treatment did not maintain PASI and returned to standard doses. Effectiveness at week 24 was 89.3% for 28 patients (insufficient data available for 4 patients). 3 patients lost effectiveness at week 24: 1 patient with ETA/10 days, 1 with UST/20 weeks and 1 with ADA/21 days. Patients’ treatment distribution was: 12 ADA/21 days and 5 ADA/28 days; 9 ETA/10 days and 2 ETA/14days; 3 UST/16 weeks and 1 UST/20 weeks. Mean DLQI after and before dose optimisation was maintained in 1. At week 24, DLQI was above 10 in 1 patient. There were no adverse drug events.
Conclusion Efficacy was maintained after biological therapy dose optimisation in most of the mmP patients. Adalimumab was the most frequent biological drug optimised, followed by etanercept and ustekinumab. Safety and quality of life after drug dose reduction was maintained in most patients.
No conflict of interest
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