International consensus on dose reduction of biologics for patients with psoriasis: The DR. Delphi study

Dose reduction (DR) of biologics for psoriasis is already applied in clinical practice but without clear guidelines, while dermatologists addressed the need for guidance. An international consensus may contribute to optimal implementation of biologic DR in clinical psoriasis practices.

This consensus study aims for international consensus on DR of biologics in adult patients with psoriasis among dermatologists worldwide.

An international, modified eDelphi consensus study was performed among dermatologists worldwide. A total of 11 statements on biologic DR were generated by the international steering committee, based on a previous literature review. Invitations were distributed via international dermatological societies. Participants rated their level of agreement per statement on a 9-point Likert scale. A maximum of three consensus rounds and one (digital) consensus meeting were expected. Statements reached consensus if ≥70% agreed and <15% disagreed; otherwise, statements were revised for a next consensus round.

In total, 62 dermatologists from Europe, South America, Asia, North America, Africa and Australia completed the eDelphi. After one round, 9 out of 11 statements reached consensus. The remaining 2 statements were adapted and reached consensus in the second round. Participants agreed on criteria when to consider and initiate/(dis)continue DR and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab. Participants agreed that this two-step DR strategy can also be considered for IL-17 and IL-23 inhibitors while awaiting more scientific evidence on DR of these newer biologics.

Dermatologists worldwide reached consensus on when and how to initiate and (dis)continue DR of biologics, and on a two-step DR algorithm for adalimumab, etanercept and ustekinumab in adult patients with psoriasis. DR of IL-17 and IL-23 inhibitors was deemed feasible; however, underlying evidence is still limited. This first international consensus provides essential information for uptake and implementation of biologic DR for psoriasis on a global scale.