Reduced doses of biological therapies in psoriasis may increase efficiency without decreasing drug survival

Off-label treatment with reduced doses of biological therapies for moderate-severe psoriasis is used, but its efficacy, safety, and persistence are not well known. We have compared reduced doses with standard an escalated doses and study predictive factors for a successful reduction of doses lasting more than 6 months. We included 303 subcutaneous treatments (33% with reduced doses and 29% with escalated doses). Eighty (80.8%) reduced treatments were successful. Patients with longer evolution of the disease or patients treated with drugs different from adalimumab presented an increased risk of failure. Median drug survival did not differ between the different dosing schedules. Adverse events percentage was higher in the group treated with standard doses. Unlike previous literature, ustekinumab is the drug most commonly used at reduced doses in the present study. We have found similar efficacy rates in patients with dose modification compared with patients with standard dose, without further persistence problems. Our results suggest that reduction of dose should be done early, at the time of reaching a good response (PASI 90 or PASI <3 in two consecutive visits) as this dosing seems to be safe and portends no problems regarding persistence or adverse effects.