Dose modulation strategies in psoriatic patients: real-world comparison between secukinumab and brodalumab for up to one year after dose spacing.

Introduction: Modulation of the regimen of biologics, including dose reduction (de-escalation) and dose augmentation (escalation), is of increasing interest in psoriatic patients.De-escalation strategies include reducing the single therapeutic dose, the mg/kg ratio or number of injections, and dose-spacing (D-S), i.e. extending the interval between administrations. Real-life data regarding dose de-escalation are lacking.

Objectives: We aim to retrospectively analyse the effectiveness and drug survival of D-S of secukinumab and brodalumab in a real-world setting.

Materials and methods: This is a cohort study with a retrospective analysis of the general characteristics and effectiveness of patients with psoriasis undergoing therapeutic biologic D-S with secukinumab or brodalumab.

Results: Eighty patients, 38.75% treated with secukinumab and 61.25% treated with brodalumab, underwent dose modulation by D-S of 50% of the approved range. After a mean of 35 months the population underwent D-S. At D-S, the mean PASI was 0.1, ranging from 0.7 to 0.1 in the following year. PASI100 was achieved by 91% at the date of D-S, and remained stable over the following year. Similar trends were seen for PASI 90 and PASI≤1 with 99%, and 100% of achievement at the time of D-S, which were maintained at 12 months post-D-S. The 12-month drug survival of the D-S regimen was 66%, with 1 in 4 patients returning to standard dosage, and PASI 100 was regained in two-third of these cases. Secukinumab showed a drug survival after D-S of 78.3% vs 58.9% of brodalumab. No differences in mean and relative PASIs at any time point after D-S were found between the two treatments.

Conclusions: Therapeutic modulation of IL-17 inhibitors in patients with psoriasis and controlled disease seems an effective therapeutic strategy that maintains efficacy for up to one year in 40% of patients. No differences were observed between secukinumab and brodalumab during the D-S regimen.