Biological therapy optimization in patients with psoriasis by reducing the dose or increasing the time interval, in a specialized centre in Colombia

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IntroductionPsoriasis is treated with biological therapy, which has led to low disease activity or even clinical clearance. The optimization (dose-tapping) process seeks to reduce biological therapy while maintaining the risk–benefit ratio. ObjectivesTo determine relapse rate in psoriasis optimization strategy (dose tapering) patients. Material and methodsCohort study (October 2015 to February 2021) of patients with psoriasis in a specialized multicentre health institution in Colombia. Selection criteria included being at least 18 years old with biological therapy and having a sustained response (DLQI=0–5; absolute PASI <3 or BSA <1) for at least 12 months. The optimization strategy was dose reduction or interval application increase. PASI >10 was defined as relapse. Rates were estimated by medication using Kaplan–Meier. ResultsOf the 467 patients with psoriasis in the cohort, 467 received biologic therapy. 12.2% (n=57) of those who met the inclusion criteria were men, with a median age of 57 years (IQR: 44–66), disease evolution time of 15 years (IQR: 5–30), and time in optimization of 8 months (IQR: 1.54–13.2). Because of the increased application interval, the optimization strategy was 85.8%; 24.5% (n=14) received ustekinumab, 35% (n=20) received adalimumab, 15.8% (n=9) received secukinumab, 14% (n=8) received ixekizumab, 5.2% (n=3) received etanercept, and 5.2% (n=3) received guselkumab. A total of 14% (8 patients) relapsed, the relapse rate was 7.4 cases per 100 person-years (95% CI: 3.4–14). ConclusionsEighty-six percent of patients in the optimization strategy remain relapse-free after 8 months. The optimization strategy was effective, with a low relapse rate.