Tapering and discontinuation of systemic medications in psoriasis patients with low disease activity

Shi, Liqing; Lian, Ni; Liu, Lihao; Chen, Min

doi:10.1111/dth.13599

Cited by 8 publications

(5 citation statements)

References 50 publications

(125 reference statements)

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“…Data on relapse rates with MTX treatment are highly variable, owing to the difference in dosing, tapering regimens and the use of other topical drugs. 16 While some researchers suggest low-dose or low-frequency MTX maintenance therapy to prevent relapse, 17 others are concerned about increased total cumulative dose and dose-related hepatotoxicity with its long-term use. In one study, 45% patients relapsed within 6 months of stopping treatment with low-dose oral MTX in psoriasis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis

Dogra

Singh

Kumar

et al. 2022

Dermatologic Therapy

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Subcutaneous (SC) methotrexate (MTX) is considered to be associated with a higher and predictable linear bioavailability as compared to oral MTX. Although various studies have reported SC MTX to be safe and effective in psoriasis, prospective head-to-head comparative trials on oral versus SC MTX are limited. To compare the efficacy and safety of SC versus oral MTX in severe psoriasis. It was a prospective, single-blinded, randomized controlled trial, in 100 eligible, adult patients of severe psoriasis randomized into two groups. Group-A (n = 50) patients were started on oral MTX at a full dose of 0.3 mg/kg/week (maximum 25 mg/week) given for 12 weeks or till achieving PASI90 [90% reduction in Psoriasis Area Severity Index (PASI) from baseline], whichever was earlier and group-B (n = 50) patients received SC MTX in the same dose and duration. MTX was then tapered gradually at 5 mg every 2 weeks and stopped. All patients were followed-up for 24 weeks post-treatment with monthly assessment of PASI and Dermatology Life Quality Index (DLQI) scores.Baseline demographic profiles of patients in both the groups were comparable. The mean ± SD baseline PASI scores were group-A: 15.1 ± 3.2 versus group-B:15.7 ± 3.3 (p = 0.35). The number of patients that achieved PASI90 at or before 12 weeks of treatment was numerically higher in group-B (39/50, 78%) versus group-A (31/50, 62%; p = 0.08) and the time to achieve PASI90 was significantly lesser (p < 0.001). Also, the percentage(%) decline in DLQI was significantly higher in group-B (p = 0.003). The overall side-effect profile was comparable between groups (p = 0.31), but the frequency of gastrointestinal side-effects was significantly less in group-B (p = 0.04). Among those patients who achieved a PASI90 response by week12, relapse rates were comparable during the subsequent 24-week follow-up period [group-A: 12/31 (39%), group-B: 11/39 (28%), and p-value = 0.33]. SC MTX results in a significantly faster achievement of PASI90 and greater reduction in DLQI as compared to oral MTX in patients who are candidates for systemic therapy with a comparable safety profile. CTRI/2018/01/011373, date of registration: 15 January, 2018; trial registered prospectively.

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Section: Discussionmentioning

confidence: 99%

Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis

Dogra

Singh

Kumar

et al. 2022

Dermatologic Therapy

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“…Doses of biologics can also be tapered or discontinued when patients achieve clear skin or low disease activity to reduce adverse effects and financial burden. However, this approach carries a risk of relapse for a significant proportion of patients with treatment needing to be reinstated at their standard doses [ 79 ]. Recently, a retrospective study by Armstrong et al evaluated switch patterns among 11,526 patients with psoriasis who initiated treatment with targeted (biologic or Apremilast) therapy and subsequently switched to another non-targeted therapy.…”

Section: Unmet Medical Needs and Potential Role Of Biosimilarsmentioning

confidence: 99%

Increasing Access to Effective Systemic Treatments in Patients with Moderate-to-Severe Psoriasis: Narrative Review

Girolomoni,

Savage,

Gisondi

et al. 2023

Dermatol Ther (Heidelb)

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Psoriasis is a chronic, immune-mediated inflammatory disease with a worldwide prevalence ranging between 0.51 and 11.43%. It results in a large clinical and social burden, with patients frequently suffering from reduced quality of life, psychologic distress and debilitating comorbidities. Biologic agents are used to establish and maintain disease control in patients with moderate-to-severe psoriasis and are essential to improving quality of life. However, a substantial proportion of patients have limited access to therapy due to economics, health policies and clinical considerations, which creates clinical unmet needs that disadvantage both patients and healthcare professionals. Biosimilars are a cost-effective alternative to off-patent biologic therapies, and there is mounting evidence to suggest they offer a valuable pharmacoeconomic strategy to lower healthcare costs in patients with psoriasis. Furthermore, the introduction of biosimilars can increase the number of patients able to receive biologics, allowing these patients to be treated earlier in the disease course, potentially modifying the course of their disease and reducing the risk of comorbidities. In time, the emergence of additional data, particularly those related to long-term safety, efficacy in extrapolated indications and the effects of switching, should reassure physicians and help overcome the final hurdles for a wider implementation of biosimilars. This review aims to provide an overview of current treatment approaches for patients with moderate-to-severe psoriasis in the biosimilars era and explores both the current challenges and potential opportunities to improve access to high-quality, effective treatments.

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“…Different treatment approaches, such as low-dose long-term or weekend maintenance treatments, have also been found to be effective. It should not be used for longer than 1-2 years, even when used at low doses for a long time [35][36][37][38][39][40].…”

Section: Cyclosporinementioning

confidence: 99%

How should we do in the selection and follow-up of systemic conventional treatments in psoriasis?

Akarsu

2023

Explor Musculoskeletal Dis

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There is an increasing need for appropriate effective treatment and long-term disease control in patients with psoriasis because of the decreased quality of life, increased physicosocial deficits and associated co-morbidities. Systemic conventional treatments that are the first step in the management of moderate-to-severe plaque psoriasis include methotrexate (MTX), acitretin, cyclosporine and fumarates. MTX is considered the gold standard in the treatment of moderate-to-severe chronic plaque type psoriasis. It is also used to treat pustular psoriasis, erythrodermic psoriasis and psoriatic arthritis. Acitretin monotherapy is less effective than other conventional systemic treatments for plaque psoriasis, while superior to generalized, palmoplantar pustular, and hyperkeratotic variants. Cyclosporine is preferred in the presence of unstable acute clinical conditions (erythrodermic or generalized pustular psoriasis) and also in induction phase of rotational and sequential therapy for severe resistant psoriasis, due to its rapid effect. Dimethyl fumarate, which has similar efficacy to MTX, is an appropriate option in the induction and long-term systemic treatment for adult patients with moderate to severe plaque psoriasis without psoriatic arthritis. Although they are often overshadowed by biologics at the stage of preference by most physicians and patients today, they are classical and inexpensive agents with known long-term results. When the appropriate patient profile and psoriasis type are selected at the right time and necessary laboratory and clinical follow-ups are made, each of them is an effective treatment with reliable and satisfactory results. In this article, important points (recommendations according to patient characteristics, psoriasis type and comorbidities) to be considered in clinical practice when using the conventional anti-psoriatic agents in the treatment of psoriasis are overviewed.

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Tapering and discontinuation of systemic medications in psoriasis patients with low disease activity

Cited by 8 publications

References 50 publications

Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis

Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis

Increasing Access to Effective Systemic Treatments in Patients with Moderate-to-Severe Psoriasis: Narrative Review

How should we do in the selection and follow-up of systemic conventional treatments in psoriasis?

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