Patients receiving biologic treatment for psoriasis who achieve complete skin clearance may be able to discontinue the biologic treatment while maintaining long-term disease control, according to study findings in a letter to the editor published in Journal of the American Academy of Dermatology.
Researchers conducted a cohort study using data from the DERMBIO database of all Danish patients with psoriasis who were treated with biologics and the causes of treatment discontinuation. They also used linkage with nationwide registries to obtain data on concurrent treatment and comorbidities.
Adults (N=3844) treated with biologics from January 2007 through December 2016 who were followed for 24 months were included in the study. Remission was defined as discontinuation, with “remission” stated by the dermatologist as the reason and a psoriasis area and severity index (PASI) score of less than 3 at time of cessation.
A total of 40 participants discontinued biologic therapy due to remission. Among these participants, 47% were women and 60% were biologic-naive. Median age at diagnosis was 29.0 years (IQR, 15.0-44.0). Median age at prescription of treatment was 43.0 years (IQR, 30.8-58.3). There were 5 patients with concomitant diabetes and 7 patients who had psoriatic arthritis. There were 7 patients whose disease previously failed to respond to at least 2 biologic treatments, 9 patients whose disease previously failed to respond 1 biologic treatment, and 24 patients whose disease previously never failed to respond biologic treatments.
A PASI score of 0 was noted in 24 (60%) of the patients upon treatment discontinuation. Overall and for patients with a PASI score of 0, median dermatology life quality index (DLQI) at remission was 0, and for patients with a PASI score of greater than 0, median DLQI was 1.
A total of 17 participants (43%) remained in remission or initiated treatment with only topical therapy 2 years after discontinuation. The researchers noted that 12 out of 24 participants with a PASI score of 0 at discontinuation were among those in remission or managing symptoms with topical therapy only for at least 2 years. There were 5 out of 16 patients (31%) with a PASI score of greater than 0 at discontinuation who remained in remission or managed symptoms with topical therapy only for at least 2 years.
Participants were more likely to initiate topical treatment vs systemic or biologic agents. It was observed that 13 out of 18 patients restarting biologics initiated the same medication as previously discontinued. Median duration of treatment in these patients reinitiating the same drug was 768 days (IQR, 265-1200 days).
Study limitations include the design nature of reviewing data, and underpowered sample size.
“These results suggest the tantalizing possibility that some patients, especially those who achieved complete skin clearance, can discontinue their biologic treatment and still maintain long-term control of their disease,” the study authors concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Nielsen ML, Thein D, Rasmussen MK, et al. Trajectories and prognosis after discontinuation of biologics due to remission in psoriasis – a nationwide cohort study. J Am Acad Dermatol. Published online February 3, 2023. doi:10.1016/j.jaad.2023.01.029