Optimizing biologic therapy in psoriasis: dose adjustment, treatment duration, and tapering-an expert perspective

Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, long-term treatment requires optimization strategies to maintain efficacy, minimize adverse effects, and improve cost-effectiveness in real-world practice.

This narrative review summarizes current evidence on biologic optimization in psoriasis, including dose adjustment strategies (dose reduction and escalation), interval modification, switching between biologics, and treatment tapering. The role of therapeutic drug monitoring and immunogenicity in guiding treatment decisions is also discussed, along with emerging approaches such as combination biologic therapy. In addition, evolving biomarkers and computational tools, like machine learning, may enable the prediction of treatment response and guide personalized therapy. A structured literature review of published clinical trials, real-world studies, and review articles was undertaken to evaluate existing evidence and identify gaps in current practice.

Biologic optimization should follow an individualized, mechanism-based approach integrating clinical response, pharmacokinetic variability, and patient-specific factors. While current evidence is heterogeneous, future research focusing on validated biomarkers, therapeutic drug monitoring, and artificial intelligence-driven models will be critical in advancing precision medicine and improving the optimization, durability and cost-effectiveness of biologic therapy.