Less Is More

INTRODUCTIONChronic plaque psoriasis is commonly treated with IL-17 and IL-23 inhibitors, which are highly effective but associated with substantial costs. Because many patients achieve long-term disease control, fixed-dose regimens may result in overtreatment.

OBJECTIVESThis study assessed the economic impact of disease-activity-guided dose reduction (DR) strategies using secukinumab, brodalumab, guselkumab, and risankizumab in adults with stable plaque psoriasis.

METHODSThis cost analysis was based on data from the PSORED trial, a multicenter prospective open-label study conducted in Piedmont, Italy (2023-2025). Patients with stable disease (PASI ≤3, DLQI ≤3 for ≥9 months) underwent DR trough a 1.5x extension of maintenance dosing intervals. Costs under DR and standard dosing (SD) were compared over 52 weeks using Italian tariff data and real-world treatment patterns.

RESULTSAmong 156 enrolled patients, 39 discontinued DR, 38 returned to standard dosing, and one switched therapy. DR reduced biologics consumption without increasing follow-up requirements, yielding a 26% decrease in total costs and an average annual saving of €7,303.57 per patient.

CONCLUSIONSDR was both clinically effective and cost-saving, maintaining disease control without major safety concerns. These findings support the implementation of DR strategies in routine clinical practice to enhance long-term sustainability while preserving therapeutic efficacy.

Abstract from PubMed