Temporary interruption of biologics in plaque psoriasis generally safe, effective

Withdrawal and reinitiation of treatment with most biologic agents had minimal impact on efficacy in plaque psoriasis, according to a study.

“While biological treatments for chronic plaque psoriasis should be administered continuously to maximize and maintain efficacy, interruptions in therapy may be necessary for a number of reasons,” Charlie Yue Wang, MBBS, of the department of clinical trials at the Skin Health Institute in Victoria, Australia, and colleagues wrote.

The current systematic review of the Medline, Embase and ACP Journal Club databases yielded 35 articles pertaining to the efficacy, safety and immunogenicity of biologic agents. Eligibility criteria called for trials evaluating continuous therapy versus dosing-as-needed treatment. There were 13 controlled trials included overall.

Three of the drugs that underwent analysis included etanercept, infliximab and secukinumab. The researchers noted that these drugs have demonstrated superior efficacy when administered continuously.

However, withdrawal studies have been conducted in a number of other therapies, including etanercept, adalimumab, brodalumab, guselkumab, ixekizumab, risankizumab, tildrakizumab and ustekinumab. Results from these analyses have shown no significant impact on skin clearance rates as a result of interruption and reinitiation of therapy.

For example, in two studies of etanercept, response rates in patients who withdrew therapy and were then re-treated were 64.3% and 66.7%, respectively, while response rates in those who continued therapy were 71% and 70%.

Patients on adalimumab who were re-treated yielded a response of 73% compared with 84% for continuous therapy.

Various doses of brodalumab, ixekizumab and ustekinumab were associated with response rates ranging from 70% to percentages in the mid-80s in both the withdrawal and continuous therapy groups. In some cases, withdrawal and then reinitiation led to slightly higher response rates than continuous treatment.

Findings for guselkumab showed an 80.4% response for patients who withdrew and reinitiated and 86% for patients who continued therapy, while data for two doses of tildrakizumab showed that withdrawal and reinitiation demonstrated responses greater than 83%, depending on the dose.

For risankizumab, withdrawal and re-treatment carried a response rate of 83.7%, compared with a continuous treatment rate of 81.1%.

Safety data from one study showed that temporary interruption of infliximab may lead to serious infusion reactions. Beyond this data point, however, withdrawal and re-treatment with other drugs in the analysis was not associated with serious events.

“Most agents will regain efficacy after reintroduction,” the researchers concluded.