Intermittent use of biologic agents for the treatment of psoriasis in adults

Abstract

Current clinical recommendations suggest that continuous treatment of moderate‐to‐severe psoriasis with biologic agents is more effective than intermittent treatment in terms of achieving remission and maintaining it. Intermittent treatment, however, may provide an alternative approach in patients unwilling or unable to maintain a continuous regimen, such as those who would prefer a ‘treatment vacation’ after achieving long‐term remission, those who require treatment cessation owing to adverse events, and where insurance arrangements do not provide sufficient cover for continuous treatment. We conducted a literature search of PubMed to identify publications reporting data on the efficacy and safety of intermittent treatment with biologic agents in adults with psoriasis, specifically the use of inhibitors of tumour necrosis factor (adalimumab, certolizumab pegol, etanercept and infliximab), interleukin (IL)‐12/IL‐23 (ustekinumab), IL‐23 (guselkumab) and IL‐17 (brodalumab, ixekizumab and secukinumab). From our search, we identified 18 relevant publications reporting the intermittent use of the biologic therapies of interest: five described etanercept, three described adalimumab, two each described infliximab, ixekizumab or ustekinumab, and one each described certolizumab pegol, guselkumab, brodalumab and secukinumab. In general, there were large proportions of patients (≥60%) who were able to re‐establish disease control (as defined by each study) following re‐treatment, and the safety profiles of the various agents during re‐treatment were as anticipated from their profiles observed during continuous dosing. The exception to these general findings was infliximab, which showed the lowest rate of efficacy‐endpoint achievement (25% and 38% in two dosing groups evaluated) as well as a higher incidence of adverse infusion reactions compared with continuous dosing. In conclusion, the use of biologic agents in psoriasis is changing and current clinical data suggest that intermittent treatment may provide an effective and well‐tolerated option for certain patients.

Dose Adjustment of Biologic Treatments for Moderate-to-Severe Plaque Psoriasis in the Real World: A Systematic Review

“…One aspect of dose adjustment that was not considered in this review is intermittent dosing, although a small number of studies included interrupted dosing within the definition of dose reduction. A recent review identified 18 reports of intermittent use of biologic therapies and concluded that the majority of patients (≥ 60%) were generally able to re-establish disease control following re-treatment and that safety profiles were similar with intermittent and continuous dosing [ 30 ]. However, an earlier systematic review reported that withdrawal of treatment typically led to an increase in disease activity, and retreatment did not result in equivalent response rates to initial therapy for most biologics [ 10 ].…”

Retrospective analysis of patients with psoriasis receiving biological therapy: Real‐life data

“…Infection was treated with antifungal drug without discontinuing secukinumab. In such a condition, “intermittent treatment” may provide an alternative approach for patients whose treatment require cessation because of adverse events 37 …”

Psoriasis: Recent progress in molecular‐targeted therapies

“…111,112 Similar to IL-17 inhibitors, IL-23 inhibitors have lower immunogenicity than TNF-inhibitors, and the reproducible effect can be observed on cases that had once achieved treatment success. 88,113…”

“…IL‐17A is involved in the progression of atherosclerosis, 80 liver cirrhosis, 81‐83 and the mechanism of insulin resistance 84 . Generally, IL‐17 inhibitors have lower immunogenicity than that of TNF inhibitors, and the re‐initiation of IL‐17 inhibitor therapy shows a reproducible effect in cases that had once achieved treatment success 85‐88 …”