Work

Biologic dose reduction versus standard dosing in psoriasis: what is lost and what is gained?

Year: 2026

Type: article

Abstract: As increasing numbers of patients with psoriasis achieve stable disease control, biologic dose reduction has become an important question in maintenance treatment. This narrative review synthesizes evidence from randomized controlled trials and observational studies to compare the losses and gains of biologic dose reduction versus continued standard dosing in terms of disease control, safety, quality of life, and healthcare costs. Current evidence suggests that dose reduction may reduce the rates of high-level skin clearance, such as Psoriasis Area and Severity Index (PASI) 90 and PASI 100, and increase transient flares and disease fluctuations during maintenance treatment. By contrast, broader PASI-based response criteria may still be met by many patients after dose reduction, but this does not mean that the response achieved under standard dosing was fully preserved. The clearest gains were lower biologic use and short-term treatment costs, while improvements in quality of life or safety have not been demonstrated. Biologic dose reduction should therefore be considered a cautious, individualized strategy, with decisions informed by the magnitude of any efficacy loss, treatment burden, and patient preferences. This may help move long-term psoriasis management toward more precise and personalized treatment.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1973237

Authors: Xiya Peng, Xueqin Xu, Kun Han, Yu Sun

Institutions: Sichuan University, West China Hospital of Sichuan University, Weifang People's Hospital

Language: English

Topic: Psoriasis: Treatment and Pathogenesis

Subfield: Immunology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801