Background and Objectives: De-escalation strategies of biologics in psoriasis treatment are widespread in clinical practice. Dose spacing consists of de-escalating the time range between biological drug injections. Patients and Methods: Major objectives were: to describe trends in mean PASI, PASI 100, 90, and ≤ 1 from baseline to 12 months after dose spacing, provide drug survival analysis of dose-spaced regimens, and concurrently describe phenotypic characteristics related to the selection of patient candidates for therapeutic dose spacing. A pre-post analysis was made between mean PASI at dose spacing and baseline, and after 3, 6, 9, and 12 months following dose spacing. Results: Of 1,144 patients treated with IL-23 or IL-17 inhibitors, 61 patients underwent dose spacing. They presented with lower mean baseline Body Mass Index (BMI) (p = 0.011) and PASI (Psoriasis Area Severity Index) (p = 0.044) and were more frequently bio-experienced (p = 0.033). 12 months after dose spacing 42.9%, 85.7%, and 92.9% of observed patients achieved PASI 100, 90, and ≤1. There were no significant differences in mean PASI between dose spacing and subsequent time points. The dose spacing survival was 70% at 1 year. Conclusions: Therapeutic modulation, such as dose spacing, is an effective strategy for most psoriasis patients, resulting in a clear or almost clear skin response that is maintained over time.
IL-17 and IL-23 inhibitors dose spacing in adult psoriatic patients: a real-world pilot study
Mastorino, Luca;Ortoncelli, Michela;Bongiovanni, Eleonora;Quaglino, Pietro;Ribero, Simone
2025-01-01
Abstract
Background and Objectives: De-escalation strategies of biologics in psoriasis treatment are widespread in clinical practice. Dose spacing consists of de-escalating the time range between biological drug injections. Patients and Methods: Major objectives were: to describe trends in mean PASI, PASI 100, 90, and ≤ 1 from baseline to 12 months after dose spacing, provide drug survival analysis of dose-spaced regimens, and concurrently describe phenotypic characteristics related to the selection of patient candidates for therapeutic dose spacing. A pre-post analysis was made between mean PASI at dose spacing and baseline, and after 3, 6, 9, and 12 months following dose spacing. Results: Of 1,144 patients treated with IL-23 or IL-17 inhibitors, 61 patients underwent dose spacing. They presented with lower mean baseline Body Mass Index (BMI) (p = 0.011) and PASI (Psoriasis Area Severity Index) (p = 0.044) and were more frequently bio-experienced (p = 0.033). 12 months after dose spacing 42.9%, 85.7%, and 92.9% of observed patients achieved PASI 100, 90, and ≤1. There were no significant differences in mean PASI between dose spacing and subsequent time points. The dose spacing survival was 70% at 1 year. Conclusions: Therapeutic modulation, such as dose spacing, is an effective strategy for most psoriasis patients, resulting in a clear or almost clear skin response that is maintained over time.
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