Impact of Disease Activity-Guided Dose Reduction on IL-17 and IL-23 Inhibitors in Psoriasis: A Real-World Assessment of Efficacy, Safety, and Economic Benefits.
{"title":"Impact of Disease Activity-Guided Dose Reduction on IL-17 and IL-23 Inhibitors in Psoriasis: A Real-World Assessment of Efficacy, Safety, and Economic Benefits.","authors":"Edoardo Cammarata, Chiara Airoldi, Jacopo Colombo, Andrealuna Ucciero, Luca Mastorino, Veronica Arese, Lorenza Burzi, Franco Castelli, Massimo Chiarpenello, Francesca Graziola, Claudia Leporati, Michela Ortoncelli, Paolo Pella, Ginevra Pertusi, Alessia Pisterna, Pietro Quaglino, Simone Ribero, Gianluca Rossotto, Rossana Tiberio, Paolo Dapavo, Paola Savoia","doi":"10.5826/dpc.1503a5845","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Psoriasis is a chronic inflammatory multisystem disease for which IL-17 and IL-23 inhibitors have transformed treatment. However, high costs and the possibility of overtreatment in patients with excellent and sustained responses have driven interest in dose reduction (DR) to lower expenses without compromising efficacy.</p><p><strong>Materials & methods: </strong>We conducted a multicenter observational trial assessing the efficacy and safety of DRs for secukinumab, brodalumab, guselkumab, and risankizumab in adults with stable plaque psoriasis. Eligible participants were adults with low disease activity (PASI ≤ 3, DLQI ≤ 3 for at least 9 months). DR involved lengthening intervals to approximately 67% of the authorized standard dose. From the 361 enrolled (March 2023-January 2025), we analyzed data on 156 participants with ≥12 months of follow-up or early discontinuation due to DR failure.</p><p><strong>Results: </strong>Seventy of these patients (44.87%) received IL-17 inhibitors, and 86 (55.13%) received IL-23 inhibitors. After 52 weeks, the overall dose-reduction survival was 0.75 (95% CI: 0.69-0.82). For IL-23 inhibitor and IL-17 inhibitor cohorts, the dose-reduction survival was 0.83 (95% CI: 0.75-0.91) and 0.66 (95% CI: 0.55-0.78), respectively. Moreover, Kaplan-Meier curves suggested significant (p-value log-rank test=0.018) higher dose reduction survival for IL-23 inhibitors compared to IL-17.</p><p><strong>Discussion: </strong>Our preliminary findings suggest that extended dosing intervals for IL-17 and IL-23 inhibitors can effectively maintain disease control in stable plaque psoriasis. Larger randomized trials are needed to confirm these results, identify predictive markers of DR success, and optimize patient selection for safe and cost-effective management of psoriasis.</p>","PeriodicalId":11168,"journal":{"name":"Dermatology practical & conceptual","volume":"15 3","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339055/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dermatology practical & conceptual","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5826/dpc.1503a5845","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Psoriasis is a chronic inflammatory multisystem disease for which IL-17 and IL-23 inhibitors have transformed treatment. However, high costs and the possibility of overtreatment in patients with excellent and sustained responses have driven interest in dose reduction (DR) to lower expenses without compromising efficacy.
Materials & methods: We conducted a multicenter observational trial assessing the efficacy and safety of DRs for secukinumab, brodalumab, guselkumab, and risankizumab in adults with stable plaque psoriasis. Eligible participants were adults with low disease activity (PASI ≤ 3, DLQI ≤ 3 for at least 9 months). DR involved lengthening intervals to approximately 67% of the authorized standard dose. From the 361 enrolled (March 2023-January 2025), we analyzed data on 156 participants with ≥12 months of follow-up or early discontinuation due to DR failure.
Results: Seventy of these patients (44.87%) received IL-17 inhibitors, and 86 (55.13%) received IL-23 inhibitors. After 52 weeks, the overall dose-reduction survival was 0.75 (95% CI: 0.69-0.82). For IL-23 inhibitor and IL-17 inhibitor cohorts, the dose-reduction survival was 0.83 (95% CI: 0.75-0.91) and 0.66 (95% CI: 0.55-0.78), respectively. Moreover, Kaplan-Meier curves suggested significant (p-value log-rank test=0.018) higher dose reduction survival for IL-23 inhibitors compared to IL-17.
Discussion: Our preliminary findings suggest that extended dosing intervals for IL-17 and IL-23 inhibitors can effectively maintain disease control in stable plaque psoriasis. Larger randomized trials are needed to confirm these results, identify predictive markers of DR success, and optimize patient selection for safe and cost-effective management of psoriasis.