Frequency and outcomes of treatment dose escalation with biologics in moderate-to-severe psoriasis: a Swedish register study

• Published in: The Journal of dermatological treatment 2024-12, Vol.35 (1), p.2398170
• Main Authors: Svedbom, Axel, Wennerström, Christina, Hjelm, Fredrik, Tjärnlund, Anna, Ståhle, Mona
• Format: Article
• Language: English
• Subjects: Adalimumab - administration & dosage; Adalimumab - therapeutic use; Adult; Biological Products - administration & dosage; Biological Products - therapeutic use; comparative effectiveness research; Dermatologic Agents - administration & dosage; Dose-Response Relationship, Drug; Etanercept - administration & dosage; Etanercept - therapeutic use; Female; Humans; Male; Medicin och hälsovetenskap; Middle Aged; Psoriasis; Psoriasis - drug therapy; Registries; Severity of Illness Index; Sweden; therapeutics; Treatment Outcome; Ustekinumab - administration & dosage; Ustekinumab - therapeutic use
• ISSN: 0954-6634; 1471-1753; 1471-1753
• DOI: 10.1080/09546634.2024.2398170

The advent of biosimilars may increase the frequency of dose escalation with biologics in psoriasis. To explore the frequency and outcomes of dose escalation with adalimumab etanercept, and ustekinumab. Data were extracted from DermaReg-Pso, a psoriasis register in Stockholm, Sweden. The main exposure was treatment, and the main outcome was dose escalation. We describe outcomes with dose escalation by estimating drug survival and changes in the Psoriasis Area and Severity Index (PASI). 554 patients had 946 treatment episodes with adalimumab, etanercept, or ustekinumab. The cumulative incidence of dose escalation was 4.1 per 100 treatment years. The Hazard Ratios (HRs) for dose escalation with ustekinumab vs adalimumab and ustekinumab vs etanercept were 1.93 (95% CI: 1.25-2.98), and 2.20 (95% CI: 1.42-3.41), respectively. After dose escalation, the HRs for treatment discontinuation with adalimumab and etanercept compared with ustekinumab were 3.10 (95% CI: 1.56-6.18) and 7.15 (95% CI: 3.96-12.94), respectively. PASI was higher after compared to before dose escalation for etanercept (  = 0.036), but not for adalimumab (  = 0.832) or ustekinumab (  = 0.300). Dose escalation was comparatively more frequent with ustekinumab than with adalimumab or etanercept; however, treatment discontinuation after dose escalation was more common with adalimumab and etanercept than ustekinumab.