Challenging the limits of psoriasis treatment: a review of biologic dose-reduction strategies
DOI:
https://doi.org/10.47196/xbc87d73Keywords:
psoriasis, biological therapy, drug taperingAbstract
Biologic therapies have transformed the management of moderate-to-severe psoriasis, achieving high clinical efficacy but at a significant cost and potential for adverse effects. This review examines the current evidence on biologic dose reduction strategies, including applied protocols, effectiveness by therapeutic class, success predictors, economic impact, and safety data. Although continuous treatment remains the most effective approach, gradual dose tapering or interval extension in stable patients may be a feasible alternative. Most relapses can be controlled by resuming the standard regimen. When carefully implemented, dose reduction can maintain clinical benefits, minimize side effects, and improve cost-efficiency. Proper patient selection, close monitoring, and shared decision-making are essential. In the current context of rising healthcare costs, biologic dose de-escalation emerges as a complementary strategy with potential to enhance treatment equity and sustainability of the psoriasis.
References
I. Michielsens CAJ, van Muijen ME, Verhoef LM, van den Reek JMPA, et al. Dose tapering of biologics in patients with psoriasis: a scoping review. Drugs. 2021;81:349-366.
II. Atalay S, van den Reek JMPA, Otero ME, Njoo MD, et al. Health economic consequences of a tightly controlled dose reduction strategy for adalimumab, etanercept and ustekinumab compared with standard psoriasis care: a cost-utility analysis of the CONDOR study. Acta Derm Venereol. 2020;100:adv00340.
III. Echeverría C, Bittar M, Bourren P, Chouela E, et al. Consenso argentino sobre transición terapéutica en pacientes con psoriasis moderada a severa. Med Cutan Iber Lat Am. 2017;45:145-156.
IV. Menter A, Strober BE, Kaplan DH, Kivelevitch D, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80:1029-1072.
V. Hansel K, Bianchi L, Lanza F, Bini V, et al. Adalimumab dose tapering in psoriasis: predictive factors for maintenance of complete clearance. Acta Derm Venereol. 2017;97:346-350.
VI. Baniandrés O, Rodríguez-Soria VJ, Romero-Jiménez RM, Suárez R. Dose modification in biologic therapy for moderate to severe psoriasis: a descriptive analysis in a clinical practice setting. Actas Dermosifiliogr. 2015;106:569-577.
VII. Nast A, Smith C, Spuls PI, Avila Valle G, et al. EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol. 2020;34:2461-2498.
VIII. Nast A, Smith C, Spuls PI, Avila-Valle G, et al. EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatol Venereol. 2021;35:281-317.
IX. Lavieri A, Acevedo A, Baccarini E, Crespo MA, et al. Consenso Nacional de Psoriasis: guía de tratamiento. Actualización 2022. Sociedad Argentina de Dermatología; 2022.
X. Al-Hammadi A, Ruszczak Z, Magariños G, Chu CY, et al. Intermittent use of biologic agents for the treatment of psoriasis in adults. J Eur Acad Dermatol Venereol. 2021;35:360-367.
XI. Atalay S, van der Schoot LS, Vandermaesen L, van Vugt LJ, et al. Evaluation of a one-step dose reduction strategy of adalimumab, etanercept and ustekinumab in patients with psoriasis in daily practice. Acta Derm Venereol. 2021;101:adv00463.
XII. Wang CY, Foley P, Baker C, Rademaker M. Biological therapy interruption and re-treatment in chronic plaque psoriasis. J Drugs Dermatol. 2021;20:1063-1071.
XIII. Atalay S, van den Reek JMPA, den Broeder AA, van Vugt LJ, et al. Comparison of tightly controlled dose reduction of biologics with usual care for patients with psoriasis: a randomized clinical trial. JAMA Dermatol. 2020;156:393-400.
XIV. Mrowietz U, Leonardi CL, Girolomoni G, Toth D, et al. Secukinumab retreatment-as-needed versus fixed-interval maintenance regimen for moderate to severe plaque psoriasis: a randomized, double-blind, noninferiority trial (SCULPTURE). J Am Acad Dermatol. 2015;73:27-36.e1.
XV. Blauvelt A, Papp KA, Sofen H, Augustin M, et al. Continuous dosing versus interrupted therapy with ixekizumab: an integrated analysis of two phase 3 trials in psoriasis. J Eur Acad Dermatol Venereol. 2017;31:1004-1013.
XVI. Umezawa Y, Torisu-Itakura H, Morisaki Y, ElMaraghy H, et al. Long-term efficacy and safety results from an open-label phase III study (UNCOVER-J) in Japanese plaque psoriasis patients: impact of treatment withdrawal and retreatment of ixekizumab. J Eur Acad Dermatol Venereol. 2019;33:568-576.
XVII. Reich K, Armstrong AW, Foley P, Song M, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: results from the phase III, double-blind, placebo- and active comparator-controlled VOYAGE 2 trial. J Am Acad Dermatol. 2017;76:418-431.
XVIII. Blauvelt A, Leonardi CL, Gooderham M, Papp KA, et al. Efficacy and safety of continuous risankizumab therapy vs treatment withdrawal in patients with moderate to severe plaque psoriasis: a phase 3 randomized clinical trial. JAMA Dermatol. 2020;156:649-658.
XIX. Piaserico S, Gisondi P, De Simone C, Marinello E, et al. Down-titration of adalimumab and etanercept in psoriatic patients: a multicentre observational study. Acta Derm Venereol. 2016;96:251-252.
XX. van der Schoot LS, Atalay S, Otero ME, Kievit W, et al. Regaining adequate treatment responses in patients with psoriasis who discontinued dose reduction of adalimumab, etanercept or ustekinumab. Br J Dermatol. 2022;187:1028-1030.
XXI. van Bezooijen JS, van Doorn MBA, Schreurs MWJ, Koch BCP, et al. Prolongation of biologic dosing intervals in patients with stable psoriasis: a feasibility study. Ther Drug Monit. 2017;39:379-386.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 on behalf of the authors. Reproduction rights: Argentine Dermatology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
El/los autor/es tranfieren todos los derechos de autor del manuscrito arriba mencionado a Dermatología Argentina en el caso de que el trabajo sea publicado. El/los autor/es declaran que el artículo es original, que no infringe ningún derecho de propiedad intelectual u otros derechos de terceros, que no se encuentra bajo consideración de otra revista y que no ha sido previamente publicado.
Le solicitamos haga click aquí para imprimir, firmar y enviar por correo postal la transferencia de los derechos de autor
