AI Article Synopsis
- Biologics for psoriasis can be safely reduced in dosage for patients with low disease activity to avoid overtreatment and reduce costs, though concerns about increased anti-drug antibody (ADA) formation exist.
- * The study involved 118 patients who were randomly assigned to either dose reduction (DR) or usual care (UC) over one year, examining serum drug concentrations and ADA levels.
- *Results showed no significant difference in ADA levels for adalimumab between DR and UC, and no relevant ADA development for ustekinumab; this suggests that dose tapering may not increase immunogenicity in low disease activity psoriasis patients.
Article Abstract
Background: Biologics for psoriasis are registered in standard dosages. In patients with low disease activity, reduction of the dose by interval prolongation can prevent overtreatment, and lower risks and costs. However, fear for increased anti-drug antibody (ADA) formation due to interval prolongation of biologics is an important barrier.
Objective: To investigate the course of serum drug concentrations, ADA levels, and predictors for successful dose reduction of adalimumab, ustekinumab, and etanercept for psoriasis.
Methods: Patients were randomized to dose reduction (DR) or usual care (UC) and followed for one year. The course and extent of detectable ADA levels were expressed as proportions/relative risks for DR UC. Association of baseline characteristics with successful tapering was investigated with log-binomial regression analysis.
Results: In total, 118 patients were included. In adalimumab-treated patients, no significant difference in the proportion of patients with relevant ADA levels in DR UC was seen. For ustekinumab, relevant ADA development was absent in both groups. Baseline trough levels were not predictive for successful DR.
Conclusions: Immunogenicity may not increase by interval prolongation in psoriasis patients with low disease activity. This pilot provides important and reassuring insight into the pharmacological changes after dose tapering of adalimumab, etanercept, and ustekinumab.
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| http://dx.doi.org/10.1080/09546634.2022.2043546 | DOI Listing |
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