Early Use of Beneficial Biological Therapy on Younger Psoriasis Patients: Could a 'Step-Down' Therapy Approach Be More Effective?

Abstract

Introduction: Psoriasis is a chronic autoimmune skin disorder affecting roughly 2% of the population worldwide. This condition manifests variably due to individual phenotypes. As the number of therapies has increased, Belgium established its own registry. However, these treatments are often inaccessible due to reimbursement criteria. This study suggests that some groups of psoriasis patients (particularly younger patients) may selectively benefit from early treatment approaches with biological therapies.

Material and methods: Patients diagnosed with psoriasis included in the Belgian Psoriasis Registry were included in the study. Collected data included socio-demographic changes, lifestyle changes, psoriasis-related characteristics, treatment specifics and treatment changes, and associated diseases.

Results: Two hundred and five patients were included. Patients were classified as responders if their Psoriasis Area Severity Index (PASI) score decreased by more than 75% between the initial visit and follow-up (PASI75). 47% of patients achieved PASI75. In the short-term, 50% of patients treated with biologic therapy, 30.5% on systemic conventional therapies, and 32.25% on topicals/phototherapy responded with PASI75. At long-term follow-up, an increase in response was observed in patients receiving biologic therapy, as well as in patients undergoing systemic conventional therapy (55.5%). Patients receiving treatment shortly after their first lesions' onset had better responses (p value < 0.0001).

Conclusion: Intervening earlier with effective treatments improves outcomes, particularly in younger patients. Treatment algorithms should use a step-down approach rather than a step-up approach. This would enhance the number of responders and potentially reduce costs.