Biological therapy optimization in patients with psoriasis by reducing the dose or increasing the time interval, in a specialized centre in Colombia

Introduction: Psoriasis is treated with biological therapy, which has led to low disease activity or even clinical clearance. The optimization (dose-tapping) process seeks to reduce biological therapy while maintaining the risk–benefit ratio. Objectives: To determine relapse rate in psoriasis optimization strategy (dose tapering) patients. Material and methods: Cohort study (October 2015 to February 2021) of patients with psoriasis in a specialized multicentre health institution in Colombia. Selection criteria included being at least 18 years old with biological therapy and having a sustained response (DLQI = 0–5; absolute PASI <3 or BSA <1) for at least 12 months. The optimization strategy was dose reduction or interval application increase. PASI >10 was defined as relapse. Rates were estimated by medication using Kaplan–Meier. Results: Of the 467 patients with psoriasis in the cohort, 467 received biologic therapy. 12.2% (n = 57) of those who met the inclusion criteria were men, with a median age of 57 years (IQR: 44–66), disease evolution time of 15 years (IQR: 5–30), and time in optimization of 8 months (IQR: 1.54–13.2). Because of the increased application interval, the optimization strategy was 85.8%; 24.5% (n = 14) received ustekinumab, 35% (n = 20) received adalimumab, 15.8% (n = 9) received secukinumab, 14% (n = 8) received ixekizumab, 5.2% (n = 3) received etanercept, and 5.2% (n = 3) received guselkumab. A total of 14% (8 patients) relapsed, the relapse rate was 7.4 cases per 100 person-years (95% CI: 3.4–14). Conclusions: Eighty-six percent of patients in the optimization strategy remain relapse-free after 8 months. The optimization strategy was effective, with a low relapse rate.