Dose adjustment of biologic therapies for psoriasis in dermatological practice: a retrospective study.
BACKGROUND
Despite the large routine use of biologic drugs in psoriasis treatment, the majority of studies do not take into consideration dose-adjustment practice in 'real-life' dermatological setting. In routine clinical practice, the disease management may include a large number of conditions requiring non-standard dosage regimens, including dose escalation, dose reduction and/or off-label treatment interruption.


OBJECTIVE
The ONDA (Outcome of non-standard dosing regimen in Psoriasis and Psoriatic Arthritis) study aim was to retrospectively analyse dose-adjustment strategies among biologic therapies for psoriasis in dermatological practice during a 3-year period.


RESULTS
This retrospective, observational, multicentre study was carried out in 350 patients (68% male, 32% female) affected by plaque-type psoriasis (Pso) with a coexistence of psoriatic arthritis in 164 patients (46.9%). At baseline mean PASI score was 14.9 (SD 7.2). Dose adjustment was demonstrated to be a common practice with 70/350 patients (20%) who needed a dose variation during the treatment time, in particular a dose increase in 20/70 patients (28.6%) and a dose reduction in 50/70 patients (71.4%). Dose increase was due to inefficacy on Pso parameters in 60% of cases and to inefficacy of PsA parameters in 40% of cases, while dose reduction (or temporary off-label treatment interruption) was due to prolonged remission in 54% of cases, other reason in 18% of cases, patient choice or request in 14% of cases, occurrence of concomitant event in 12% of cases.


CONCLUSIONS
Dose adjustment is a common clinical practice, consisting of frequent dose reduction when a disease prolonged remission is obtained or dose increase to improve efficacy on Pso and PsA disease parameters.
Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy.
M
M
Esposito
Department of Dermatology, University of Verona, Verona, Italy.
P
P
Gisondi
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
A
A
Conti
Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy.
A
A
Giunta
Department of Dermatology, University of Verona, Verona, Italy.
M
M
Del Giglio
Department of Dermatology, University of Verona, Verona, Italy.
M
M
Di Mercurio
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
L
L
Veneziano
Informa, Rome, Italy.
G
G
Ferrucci
Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy.
L
L
Bianchi
Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy.
S
S
Chimenti
Department of Dermatology, University of Verona, Verona, Italy.
G
G
Girolomoni
D000328:Adult; D001688:Biological Products / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D001688:Biological Products