Background and importance The goal of psoriasis treatment is to achieve and maintain the widest possible clearance of lesions and control of systemic inflammation over the long term. Biological therapies (BT) are only indicated moderate-severe psoriasis (MSP) refractory to conventional systemic therapy. In patients with sustained total clearance of lesions (TCL), dose reduction (DR) and dose spacing (DS) are optimisation strategies used in clinical practice to reduce the risk of the appearance of adverse effects (AE) and optimise resources.
Aim and objectives Describe the effectiveness and safety of BT in MSP, and measure the economic impact of optimisation strategies in clinical practice.
Material and methods An observational and retrospective study was performed in MSP patients treated with BT from 12 January to October 2021. We registered: sex, age, responders patients (RP): Psoriasis Area and Severity Index (PASI) ≥75% reduction in baseline PASI, time to loss of response (TTLOR), patients with TCL: PASI-100, patients with loss of response (LOR), duration of TCL (DTCL), causes of end of treatment (EOT) and AE due to BT. Patient data were obtained from the corporate prescription programme and electronic medical history.
Direct costs between the use of DS instead of optimised dose were compared in order to calculate the economic saving.
Results During the study period, 36 patients were included (51.42% male). Mean age was 53 (28–77) years. The proportion of RP was 94.29% and 48.57% achieved TCL with a mean DTCL of 35.5 months. 25.71% of patients had LOR with a mean of 31 months. The main causes of EOT were: no response (2.86%), LOR (25.71%) and pregnancy (8.57%). Physicians used optimisation strategies in 11 patients (31.42%) meaning an expenditure reduction of €116.386, while in 3 patients (8.3%) the dose was intensified due to lack of disease control. Regarding safety, 3 patients suffered SE: erythema (2) and weight gain (1).
Conclusion and relevance BT was effective in most cases with an acceptable safety profile. Moreover, optimisation strategies meant an expenditure reduction with a huge optimisation of the resources available in our hospital.
Correct follow-up of the patients is very important to detect which patients might benefit from optimisation strategies, treatment change or intensification.
Conflict of interest No conflict of interest
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