Can Dose Spacing of IL-17i Maintain Efficacy in Psoriasis?
Dose spacing of interleukin-17 (IL-17) inhibitors maintained therapeutic efficacy in patients with stable psoriasis, with no substantial differences observed between secukinumab and brodalumab and acceptable survival of the dose-spacing regimen for up to 12 months.
METHODOLOGY:
This retrospective cohort study analysed the effectiveness and survival of patients with psoriasis undergoing therapeutic biologic dose spacing of secukinumab or brodalumab.
The analysis included 80 patients; 38.75% of them received secukinumab and 61.25% received brodalumab.
Dose spacing was defined as extending secukinumab dosing to every 6 weeks and brodalumab to every 3 weeks after induction. All patients underwent 50% dose spacing of the approved range after a mean treatment duration of 35 months.
Researchers monitored mean Psoriasis Area Severity Index (PASI) scores, PASI100, PASI90, and PASI ≤ 1. The mean follow-up duration under the dose-spacing regimen was 6.7 months.
TAKEAWAY:
The mean PASI value was 0.7 after 3 months of dose spacing and 0.1 after 12 months. No significant differences in mean PASI scores were observed between secukinumab and brodalumab at any timepoint after dose spacing.
PASI100 achievement was 91.25% at dose-spacing initiation and remained stable throughout the following year; 99% of patients achieved PASI90 and 100% achieved PASI ≤ 1 at dose-spacing initiation, and both rates were maintained at 12 months.
The 12-month drug survival rate for the dose-spacing regimen was 66.1%, with 25% of patients returning to standard dosage and 66.7% of these cases regaining PASI100.
Secukinumab demonstrated higher drug survival after dose spacing than brodalumab (78.3% vs 58.9%).
IN PRACTICE:
"No significant differences in effectiveness were found between secukinumab and brodalumab in patients undergoing a D-S [dose-spacing] regimen. Overall, dose de-escalation of IL-17 inhibitors in patients with psoriasis who have achieved a stable response seems an effective therapeutic strategy, even if 2 of 5 patients returned to the original regimen after 1 year. When coming back to the standard regimen after D-S, PASI was regained by two-thirds of patients after 6 months," the authors of the study wrote.
SOURCE:
This study was led by Luca Mastorino, Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. It was published online on June 12, 2025, in Clinical and Experimental Dermatology .
LIMITATIONS:
The study's real-life design and retrospective nature may have introduced potential biases. The relatively small sample size could have affected the generalisability of the findings. The analysis of observed cases may have affected the interpretation of long-term outcomes.
DISCLOSURES:
This study did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors reported having no relevant conflicts of interest.
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