Intermittent use of biologic agents for the treatment of psoriasis in adults
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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 tumor 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:: 5 described etanercept, 3 described adalimumab, 2 each described infliximab, ixekizumab or ustekinumab, and 1 each described certolizumab pegol, guselkumab, Accepted Article This article is protected by copyright. All rights reserved 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.