Dose adjustment of biologic therapies for psoriasis in dermatological practice: a retrospective study

Abstract

Introduction

Despite the large routine use of biologic drugs in psoriasis treatment, the majority of studies do not take into consideration dose-adjustment practice in "real life" dermatological setting.

In routine clinical practice the disease management may include a large number of conditions requiring non-standard dosage regimens, including dose-escalation, dose-reduction and/or off-label treatment interruption.

Objective

The ONDA (Outcome of non-standard dosing regimen in Psoriasis and Psoriatic Arthritis) study aim was to retrospectively analyse dose-adjustment strategies among biologic therapies for psoriasis in dermatological practice during a 3-year period.

Results

This retrospective, observational, multicentre study was carried out in 350 patients (68% male, 32% female) affected by plaque-type psoriasis (Pso) with a coexistence of psoriatic arthritis in 164 patients (46.9%). At baseline mean PASI score was 14.9 (SD 7.2). Dose-adjustment was demonstrated to be a common practice with 70/350 patients (20%) who needed a dose-variation during the treatment time, in particular a dose-increase in 20/70 patients (28.6%) and a dose-reduction in 50/70 patients (71.4%). Dose-increase was due to inefficacy on Pso parameters in 60% of cases and to inefficacy of PsA parameters in 40% of cases, while dose-reduction (or temporary off-label treatment interruption) was due to prolonged remission in 54% of cases, other reason in 18% of cases, patient choice or request in 14% of cases, occurrence of concomitant event in 12% of cases.

Conclusion

Dose-adjustment is a common clinical practice, consisting of frequent dose-reduction when a disease prolonged remission is obtained or dose-increase to improve efficacy on Pso and PsA disease parameters.

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