Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;81(3):349-366.
doi: 10.1007/s40265-020-01448-z.

Dose Tapering of Biologics in Patients with Psoriasis: A Scoping Review

C A J Michielsens #  1   2   3 , M E van Muijen #  4   5 , L M Verhoef  6 , J M P A van den Reek  4   5 , E M G J de Jong  4   5   7
Affiliations

Dose Tapering of Biologics in Patients with Psoriasis: A Scoping Review

C A J Michielsens et al. Drugs. 2021 Feb.

Abstract

Introduction: Biologics serve as a cornerstone in psoriasis treatment, with low disease activity or sometimes even clinical remission as a realistic treatment outcome. So far, it is unclear whether biologics should be tapered when this target is achieved. Dose tapering could offer potential benefits by decreasing side effects, the burden of repetitive injections and costs of biological therapy. However, clinical guidelines on dose tapering of biologicals in psoriasis patients are lacking. This scoping review was conducted to provide an overview of the current literature on dose tapering and offer guidance for clinicians in daily clinical practice.

Methods: Dose tapering is defined as the administration of a lower dose per administration, or the prolongation of the regular dose interval, after initial treatment according to the standard dosing. Four electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) were systematically searched for literature on tapering of biologics in adult patients with psoriasis from 1 January 2000.

Results: We included 19 original articles on biologic tapering in psoriasis patients: four randomized controlled trials and 15 observational studies. Tapering eligibility criteria, tapering strategies, tapering outcomes, and recapture of response after relapse were assessed. Furthermore, the available evidence on possible predictors for successful tapering, and the effect of tapering on safety, quality of life and costs is summarized. The definition of low disease activity as a measure for tapering eligibility varied widely. Beside tapering criteria, tapering strategies were also heterogeneous. Of note, quality-of-life measurements were barely integrated in the evaluation of tapering outcomes. Literature on regaining response after relapse due to tapering was limited, but restored remission has been described. The included studies did not proclaim a significant effect of tapering on the occurrence of (severe) adverse events. Even though cost savings have been reported, no proper cost-effectiveness analysis has been conducted yet.

Conclusion: Biologic tapering seems to be effective and safe in psoriasis patients with stable low disease activity or clinical remission. Available data on biologic dose tapering in patients with psoriasis are promising, but more research is warranted to fill the current gaps in knowledge.

Plain language summary

Biologics are effective in treating psoriasis amongst other diseases, such as rheumatoid arthritis and Crohn’s disease. However, biologics are costly, and can cause side effects, such as an increased risk of infection. In patients with rheumatoid arthritis, it is not uncommon to lower the dose of these biologics (also called “dose tapering”), once stable low disease activity, or even remission, is reached. However, in psoriasis patients, dose tapering of biologics is not common practice. In this “scoping review,” we provide an overview of the available literature on dose tapering of biologics in adult patients with plaque psoriasis in order to address the current gaps in literature. We found 19 studies that addressed dose tapering. These studies used different criteria to determine which patients were eligible for tapering, which led to various interpretations of tapering success. This made it difficult for us to draw general conclusions on which tapering criteria and strategies should be further investigated. Dose tapering seems to be effective and safe in patients with a stable low disease activity, although more (high-quality) research is needed. Future studies should focus on generating more data on long-term safety, finding predictors for successful tapering, calculating the cost-effectiveness of dose tapering, and evaluating dose tapering in the newest generation of biologics.

PubMed Disclaimer

Conflict of interest statement

C. A. J. Michielsens has nothing to disclose. M. E. van Muijen carries out clinical trials for Abbvie, Celgene, Janssen, and Novartis, and has received a speaking fee from Janssen. All funding is not personal but goes to the independent Research Fund of the Department of Dermatology of the Radboud University Medical Center, Nijmegen (Radboudumc), the Netherlands. L. M. Verhoef has nothing to disclose. J. M. P.A. van den Reek has carried out clinical trials for AbbVie, Celgene, and Janssen, and has received speaking fees from/attended advisory boards for AbbVie, Janssen, BMS, and Eli Lilly, and reimbursement for attending a symposium from Janssen, Pfizer, Celgene, and AbbVie. All funding is not personal but goes to the independent research fund of the Department of Dermatology of Radboud University Medical Center, Nijmegen, the Netherlands. E. M. G. J. de Jong has received research grants for the independent research fund of the Department of Dermatology of the Radboud University Medical Center, Nijmegen, the Netherlands, from AbbVie, Novartis, Janssen Pharmaceutica, and Leo Pharma. Has acted as a consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including AbbVie, Janssen Pharmaceutica, Novartis, Lily, Celgene, Leo Pharma, UCB, and Almirall. All funding is not personal but goes to the independent research fund of the Department of Dermatology of Radboud University Medical Center Nijmegen, the Netherlands.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process. aBiologics not registered for treatment of psoriasis in Europe at the time of the review. bThe study by Na et al. [40] on dose tapering of etanercept did not specify the percentage of patients who reached PASI75 at week 12. Other reported outcomes did not fall within the scope of this review. This study was therefore excluded. cPublication of protocol only
See this image and copyright information in PMC

References

    1. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–850. doi: 10.1016/j.jaad.2008.02.039. - DOI - PubMed
    1. Zorginstituut Nederland. https://www.medicijnkosten.nl/. Accessed 24 Sep 2020.
    1. Thomaidou E, Ramot Y. Injection site reactions with the use of biological agents. Dermatol Ther. 2019;32(2):e12817. doi: 10.1111/dth.12817. - DOI - PubMed
    1. Scherer K, Spoerl D, Bircher AJ. Adverse drug reactions to biologics. J Dtsch Dermatol Ges. 2010;8(6):411–426. doi: 10.1111/j.1610-0387.2010.07339.x. - DOI - PubMed
    1. Gisondi P, Cazzaniga S, Chimenti S, Maccarone M, Picardo M, Girolomoni G, et al. Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry. Br J Dermatol. 2015;172(6):1613–1620. doi: 10.1111/bjd.13539. - DOI - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources