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. 2022 Sep;314(7):687-695.
doi: 10.1007/s00403-021-02273-4. Epub 2021 Aug 31.

Attitudes and behaviour regarding dose reduction of biologics for psoriasis: a survey among dermatologists worldwide

M E van Muijen #  1   2 , L S van der Schoot #  3   4 , J M P A van den Reek  1   2 , E M G J de Jong  1   2   5
Affiliations

Attitudes and behaviour regarding dose reduction of biologics for psoriasis: a survey among dermatologists worldwide

M E van Muijen et al. Arch Dermatol Res. 2022 Sep.

Abstract

Dose reduction (DR) of biologics, where possible, seems promising for more efficient use of expensive biologics. For implementation of DR strategies, it is essential to get insight in factors that influence implementation. The objective of this study was to evaluate the attitudes and behaviour regarding dose reduction of biologic therapies for psoriasis among psoriasis expert dermatologists worldwide. A 27-question e-survey was sent through the International Psoriasis Council (IPC) to its 114 dermatologist councilors worldwide. The survey assessed demographics, general and DR prescription behaviour, and motivations for and barriers against application of DR. Of 57 respondents, 53 respondents who prescribed biologics were included for analysis. Thirty-seven (69.8%) applied DR (i.e., 'DR dermatologists'), and 16 (30.2%) did not (i.e., 'Non-DR dermatologists'). DR strategies varied among respondents. Regarding criteria for starting DR, differences were reported in required treatment duration, and interpretation and duration of stable low disease activity. In addition, the prolongation of intervals between injections varied between respondents. For most 'DR dermatologists' (n = 32/37, 86.5%), cost savings were one of the main reasons to apply DR. Fifteen out of 16 'Non-DR dermatologists' (94%) did not apply DR due to lack of scientific evidence. In conclusion, DR of biologics for psoriasis is part of clinical practice in psoriasis experts globally. Barriers for applying DR included lack of evidence or guidelines, and uncertainty on DR effects and risks. Although growing evidence shows DR feasibility, future studies are needed to accumulate and broaden evidence, along with development of (inter)national guidelines on DR strategies.

Keywords: Biologics; Dermatologists; Dose reduction; Psoriasis; Survey.

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Conflict of interest statement

ME van Muijen carries out clinical trials for Abbvie, Celgene, Janssen and Novartis, and has received speaking fees 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. LS van der Schoot carries out clinical trials for Janssen and Novartis. 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. JMPA van den Reek carries out clinical trials for AbbVie, Celgene and Janssen and has received speaking fees/attended advisory boards from AbbVie, Janssen, BMS, Almirall, LEO Pharma and Eli Lilly and reimbursement for attending symposiums 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 (Radboudumc), The Netherlands. EMGJ 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, Pfizer, Novartis, Janssen Pharmaceuticals and Leo Pharma and has acted as 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 (Radboudumc), The Netherlands.

Figures

Fig. 1
Fig. 1
Dose reduction (DR) per biologic. Results are presented as absolute number of prescribers for each biologic, and the proportion of respondents that applied DR for each specific biologic. Respondents were first asked which biologics they prescribed. Subsequently they were asked to indicate whether they applied DR for the biologics they prescribed. Respondents who indicated to prescribe a specific biologic, but did not specify if they applied DR for that biologic, were accounted as missing. DR dose reduction
Fig. 2
Fig. 2
Dose reduction (DR) regimen per biologic. Results are presented as absolute number of prescribers for each biologic. Respondents were asked to indicate how they applied DR per biologic they prescribed. Multiple answers were possible. *33% reduction of the original dose, **50% reduction of the original dose. QW every week, Q10D every 10 days, mg milligram, kg kilogram
See this image and copyright information in PMC

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