Real-World Strategies for Biologic Dose Escalation and Reduction in Psoriasis and Psoriatic Arthritis: A Systematic Review
In brief
Biologic dose reductions maintained disease control in 50% to 90% of patients
In a review of 63 real-world studies of psoriasis and psoriatic arthritis, dose reductions were commonly tried after stable remission, and disease control persisted in 50% to 90% of patients. Dose escalation appeared most successful when moderate and started promptly, but varied definitions and outcome reporting make results hard to compare and leave clinicians without standardized guidance.
- Journal
- Journal of cutaneous medicine and surgery (Q1)
- Published
- 28 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Orsola Crespi, Isotta Giunipero di Corteranzo, Eleonora Bongiovanni, Umberto Santaniello, Michela Ortoncelli, Pietro Quaglino, et al.
- PMID
- 42806636
- DOI
- 10.1177/12034754261484596
Why clinicians should know about it
- Picked for Dermatology (paper of the day, 1 October 2026): Systematic review of biologic dose escalation/reduction in psoriasis/psA
Abstract
BACKGROUND: Biologic therapies have improved treatment of moderate-to-severe psoriasis and psoriatic arthritis. However, real-world dosing often deviates from standard protocols to address suboptimal responses, sustain long-term control, and manage safety or cost. Dose escalation (DE) and dose reduction (DR) strategies are widely used, but data on their frequency, rationale, and outcomes remain fragmented. OBJECTIVE: To systematically review real-world evidence on DE and DR practices for biologic therapies in moderate-to-severe psoriasis and psoriatic arthritis, focusing on definitions, clinical criteria, and success rates. METHODS: A systematic literature review was conducted using PubMed, Scopus, Embase, and the Cochrane Library from January 1, 2005, through December 31, 2024. Eligible studies included adults with moderate-to-severe plaque psoriasis or psoriatic arthritis receiving tumor necrosis factor inhibitors, interleukin-12 (IL-12)/IL-23 inhibitors, IL-17 inhibitors, or IL-23 inhibitors, with reported off-label dose modifications. Data on definitions, timing, clinical criteria, and outcomes were extracted and synthesized. RESULTS: From 2623 records, 63 studies were included. Dose adjustments were defined using varied clinical or timing criteria. DE was most successful when applied moderately and promptly. DR was commonly implemented after stable remission and maintained disease control in 50% to 90% of patients. Adalimumab was the most frequently adjusted biologic. IL-17 and IL-23 inhibitors also showed flexibility. Inconsistent definitions and outcome reporting limited comparability across studies. CONCLUSION: Dose adjustments are common but inconsistently defined, highlighting the need for standardized definitions and clinical guidance.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.