Biologic tapering for patients with psoriasis with low disease activity: data from the French PsoBioTeq Registry

Aubert, H.; Arlegui, Hugo; Rycke, Yann De; Bachelez, H.; Beylot‐Barry, M.; Dupuy, Alain; Joly, P.; Jullien, D.; Mahé, E.; Paul, C.; Richard, M.‐A.; Sbidian, É.; Viguier, Manuelle; Chosidow, Olivier; Tubach, Florence; Bénéton, N.

doi:10.1093/bjd/ljac024

Cited by 3 publications

(6 citation statements)

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“…Eventually, 14 new articles were included ( Figure 1 ). These articles involved four studies testing DR strategies ( Atalay et al, 2021 ; Atalay et al, 2022b ; Di Altobrando et al, 2022 ; Herranz-Pinto et al, 2023 ), one specifically focusing on the effectiveness of returning to standard dosages when DR failed ( van der Schoot et al, 2022a ), two addressing the safety of DR ( Atalay et al, 2022a ; Benzaquen et al, 2022 ), one evaluating the cost-effectiveness of DR ( Atalay et al, 2020b ), and six investigating the implementation and uptake of DR ( Aubert et al, 2022 ; van der Schoot et al, 2022b ; van Muijen et al, 2022 ; Aubert et al, 2023 ; van der Schoot et al, 2023a ; van der Schoot et al, 2023b ). All four studies testing DR strategies were cohort studies, of which three were prospective and one was retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 6 out of the 14 included studies were specifically focused on the implementation and uptake of DR ( Aubert et al, 2022 ; van der Schoot et al, 2022b ; van Muijen et al, 2022 ; Aubert et al, 2023 ; van der Schoot et al, 2023a ; van der Schoot et al, 2023b ). These studies mostly evaluated patients’ or healthcare providers’ experienced barriers or facilitators toward DR through surveys and/or interviews and also included the results of a cohort study, a national consensus study, and an implementation study of a DR protocol.…”

Section: Resultsmentioning

confidence: 99%

“…This research study reported on the results of 850 patients in the French prospective PsoBioTeq registry cohort ( Aubert et al, 2023 ). All patients were in remission or had low disease activity (R/LDA) (PASI ≤3 or PGA ≤1 and/or no psoriatic lesions during ≥2 consecutive visits).…”

Section: Resultsmentioning

confidence: 99%

“…In particular, patients using TNF-α inhibitors showed that the more rapidly remission was achieved, the sooner DR could be applied, compared to patients using IL-12/23 or IL-17 inhibitors. Age, severity, or type of psoriasis showed no significant impact ( Aubert et al, 2023 ).…”

Section: Resultsmentioning

confidence: 99%

“…Almost all IL-17 and IL-23 inhibitors were included in studies on the uptake and implementation of DR. In total, 14 articles were included ( Atalay et al, 2020b ; Atalay et al, 2021 ; Atalay et al, 2022a ; Aubert et al, 2022 ; van der Schoot et al, 2022a ; Atalay et al, 2022b ; Benzaquen et al, 2022 ; van der Schoot et al, 2022b ; Di Altobrando et al, 2022 ; van Muijen et al, 2022 ; Aubert et al, 2023 ; van der Schoot et al, 2023a ; van der Schoot et al, 2023b ; Herranz-Pinto et al, 2023 ). Multiple studies were excluded due to uncertainty in the DR strategy studied, induction scheme, or absence of effect measurements, and specifically, cost studies regarding IL-17 and IL-23 inhibitors did not include DR.…”

Section: Discussionmentioning

confidence: 99%

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Dose reduction of biologics in patients with plaque psoriasis: a review

van Riel,

Michielsens,

van Muijen

et al. 2024

Front. Pharmacol.

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Dose reduction (DR) of first-generation biologics for plaque psoriasis (TNF-alpha inhibitors (i) and interleukin (IL)-12/23i) has been described in a previous scoping review. The literature on the DR of the newest generation of biologics (IL-17/23i) was scarce. The current review provides a literature update on the previous scoping review on the DR of all biologics, including the newest generation, with a focus on the uptake and implementation of DR in practice. The current literature search on DR revealed 14 new articles in addition to those in the previous review. Four of the newly found articles tested DR strategies, mostly focusing on first-generation biologics; only guselkumab (IL-23i) was included in one study. The other 10 studies showed data on regaining response after failure of DR, safety, cost-effectiveness, and uptake and implementation, as well as information about IL-17/23i. The eligibility criteria to start DR included both absolute and relative Psoriasis Area and Severity Index (PASI) scores (PASI ≤3/≤5/PASI 75–100) and/or Dermatology Life Quality Index (DLQI) ≤3/≤5, or BSA ≤1/≤2, or Physician Global Assessment (PGA) ≤1/0–2 during a period ranging from 12 weeks to ≥1 year. Most studies used PASI ≤5 and/or DLQI ≤5 or PGA ≤1 for ≥6 months. DR strategies were mostly performed by stepwise interval prolongation in two steps (to 67% of the standard dose, followed by 50%). Some studies of IL-17/23i reduced the dose to ±25%. The tested DR strategies on stepwise or fixed DR on TNF-αi and IL-12/23i (three studies), as well as one “on-demand” dosing study on IL-23i guselkumab, were successful. In the case of relapse of DR on TNF-αi and IL-12/23i, clinical effectiveness was regained by retreatment with the standard dose. All studies showed substantial cost savings with the biologic DR of TNF-αi and IL-12/23i. The identified barriers against the implementation of DR were mainly a lack of guidelines and scientific evidence on effectiveness and safety, and a lack of time and (technical) support. The identified facilitators were mainly clear guidelines, feasible protocols, adequate education of patients and physicians, and cost reduction. In conclusion, DR seems promising, but a research gap still exists in randomized, prospective studies testing DR strategies, especially of IL-17/23i, hampering the completion of guidelines on DR. Taking into account the identified barriers and facilitators most likely results in a more successful implementation of biologic DR in practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Dose reduction of biologics in patients with plaque psoriasis: a review

van Riel,

Michielsens,

van Muijen

et al. 2024

Front. Pharmacol.

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Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice

Schoot

Janssen

Bastiaens

et al. 2023

Journal of Dermatological Treatment

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Acceptability of ‘as needed’ biologic therapy in psoriasis: insights from a multistakeholder mixed-methods study

Gleeson,

Naveed,

Moorhead

et al. 2024

British Journal of Dermatology

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Objectives Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. Current practice is that biologic therapy is continued indefinitely in these patients, contributing to a substantial long-term drug and healthcare burden. ‘As needed’ biologic therapy in psoriasis may address this, however our understanding of patient and clinician perceptions of this strategy is limited. Methods We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on ‘as needed’ biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Results Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43/64) and 78% (21/27), respectively, supported the use of ‘as needed’ biologic therapy. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of ‘as needed’ drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis (9 female [60%], average disease duration 32 years [range 9-64 years]) and 9 dermatology clinicians (8 female [89%], average dermatology experience 20 years [range 8-33 years]). Both patients and clinicians felt that an ‘as needed’ treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an ‘as needed’ approach, ongoing disease monitoring, and prompt re-access to medications upon psoriasis recurrence. Conclusion These data indicate that ‘as needed’ biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost effectiveness is warranted, to enable the real-world potential of this approach to be realised.

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Biologic tapering for patients with psoriasis with low disease activity: data from the French PsoBioTeq Registry

Cited by 3 publications

References 5 publications

Dose reduction of biologics in patients with plaque psoriasis: a review

Dose reduction of biologics in patients with plaque psoriasis: a review

Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice

Acceptability of ‘as needed’ biologic therapy in psoriasis: insights from a multistakeholder mixed-methods study

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