Three-quarters of people who respond well to the newest types of biologics for psoriasis can safely reduce their dosage, often even by half. These medications then work just as effectively, according to a study led by Radboud university medical center and Ghent University Hospital. The finding results in fewer injections and saves up to €8,500 per patient per year.
About half a million people in the Netherlands suffer from psoriasis, an inflammatory disease affecting the skin, nails, and joints. Although there is still no cure, effective medications have been introduced over the past twenty years. These biologics, inhibitors of interleukin (IL)‑17 or IL‑23, significantly reduce symptoms. 'These medicines are life-changing', says Elke de Jong, dermatologist and professor of inflammatory skin diseases. 'But people have to use them for life, and the costs are high: around €17,000 per patient per year for the newest and most effective biologics.'
Dose reduction
Researchers now show that these biologics also work well in 75% of patients at two-thirds or even just half of the standard dose. Gradual tapering of the medication under medical supervision was found to be safe and equally effective in controlling symptoms compared to a control group that continued the normal dosage. This is shown in a study of 244 patients from 19 Dutch and Belgian hospitals led by Radboudumc and Ghent University Hospital. Patients were followed for 18 months.
Reducing medication has many advantages. 'We lowered the dosage by increasing the time between injections. As a result, patients need injections less often. Some patients inject only once every six months', explains physician-epidemiologist Juul van den Reek of Radboudumc. 'This also reduces the risk of side effects and is more sustainable due to less production and transport of these medicines.'
Adjusting guidelines
According to De Jong, patients often find it exciting to taper their biologics: 'Patients are afraid that their symptoms will return. They often have a long history with psoriasis; some had symptoms for twenty years before starting biologics. That is why study participants were allowed to return to the standard dose at any time during the study if they wished, maintaining control. This made it a pragmatic study close to clinical practice.'
The researchers still strongly recommend biologics, but they would like to include in the guidelines that the dosage can often be reduced. 'This first large prospective study involving many hospitals provides sufficient evidence to start adapting the guidelines in both the Netherlands and Belgium', says professor Jo Lambert of Ghent University Hospital. 'Efficient use of healthcare resources is very relevant nowadays.'
The following biologics were studied:
- IL-17 inhibitors: secukinumab, ixekizumab, bimekizumab, brodalumab
- IL-23 inhibitors: guselkumab, risankizumab, tildrakizumab
