Evaluation of Discontinuation and Re-Initiation of Biologic Therapies in Psoriasis: Real-World Data

Discontinuation of biologic therapies in patients with psoriasis may occur for various reasons. Our study aims to evaluate the factors affecting relapse duration, clinical characteristics of patients experiencing relapses, and treatment responses in patients who discontinued biologic treatments.

Data from 121 patients with plaque psoriasis who discontinued biologic therapy were retrospectively analyzed. Linear and logistic regression analyses were used to evaluate factors influencing relapse duration and determinants of Psoriasis Area and Severity Index (PASI) 90 response after relapse, respectively.

The cumulative probability of remaining relapse-free following biologic therapy discontinuation was 35.6%, 19%, 11.6%, and 9.1% at 6, 12, 18, and 24 months, respectively. The classes of biologic therapies used at the time of treatment discontinuation, the baseline PASI score, the presence of a PASI 90 response at the time of discontinuation, and triggering factors were all found to be significant risk factors influencing relapse duration (p = 0.001, p = 0.027, p = 0.001, and p < 0.001, respectively). IL-23 inhibitors were associated with the longest relapse duration (38 weeks), followed by IL-12/23 inhibitor (21 weeks), IL-17 inhibitors (17.5 weeks), and TNF-α inhibitors (13.5 weeks). Among the 80 psoriasis patients who restarted biologic therapy, the PASI 90 response rates for TNF-α inhibitors, IL-17 inhibitors, the IL-12/23 inhibitor, and IL-23 inhibitors were 52.9%, 78.8%, 76.5%, and 92.3%, respectively.

Prolonged relapse durations were associated with a low baseline PASI score, the presence of a PASI 90 response at discontinuation, the absence of triggering factors, and the use of IL-23 inhibitors.