Tapering and discontinuation of systemic medications in psoriasis patients with low disease activity

Psoriasis is a chronic disease and often requires long-term treatment, especially in patients with moderate-to-severe psoriasis. It remains controversial whether the doses of systemic medications could be tapered or if these medications could be discontinued among patients in clinical remission. In this review, we summarize whether it is possible to taper or discontinue methotrexate, cyclosporine, and biologics while controlling the relapse rates of psoriasis. Based on the current evidence, methotrexate and biologics should not be discontinued for psoriasis patients with low disease activity. However, the doses of these medications could be tapered by reducing the maintenance dose or increasing the between-dose intervals. If the disease recurs, methotrexate and biologics should be restarted at their standard doses, and for cyclosporine, the dose can be maintained or discontinued progressively. If patients relapse, cyclosporine can be given again. The decisions to taper or discontinue anti-psoriasis drugs need to account for both benefits and risks and should be individualized according to patients' disease severity, quality of life, and presence of comorbidities.