Latin American consensus on tapering of biological therapy in psoriasis<sup/>

Londoño-García, Angela María; Castro-Ayarza, Juan Raúl; Franco, Manuel Darío Franco; Ardila, Cesar Fernando González; Magariños, Gabriel; Zaldívar, Enrique Salvador Rivas; Martínez, Susan; Ibatá, Linda; Castillo, Julieth Carolina; Rojas, Paola Jimena Cárdenas; Vargas, Evelyn Giuliana Castro; Contreras, Claudia Romina; Fernández, Claudia de la Cruz; Restrepo, Andrés Chavarriaga; Echeverria, Cristina Mariela; Carvalho, André Vicente Esteves de; Matlock, Benjamín Hidalgo; Loayza, Enrique; Maskin, Matías Rafael; Romiti, Ricardo; Valenzuela, Fernando

doi:10.1016/j.abd.2025.501134

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SPECIAL ARTICLE • An. Bras. Dermatol. 100 (4) • 2025 • https://doi.org/10.1016/j.abd.2025.501134 linkcopy

Latin American consensus on tapering of biological therapy in psoriasis^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background: Biologic therapy is an effective psoriasis treatment. However, its long-term use carries the risk of serious adverse effects and high costs for the healthcare system, which is particularly relevant in resource-limited Latin American countries. Therefore, there is scientific interest in exploring the feasibility of tapering therapy in low disease activity or clinical remission.

Objective: To provide expert consensus-based recommendations to guide personalized and efficient tapering of biologic agents in adult patients with cutaneous psoriasis.

Methods: Following an exhaustive systematic literature review, a consensus was developed using a modified Delphi methodology by a group of Latin American clinical dermatologists and an independent methodological team. The topics covered include treatment goals, tapering objectives and strategies, regimens, monitoring and tapering failure, and implementation considerations in patients with psoriasis treated with biological agents.

Results: The expert panel reached a consensus on five general principles and 13 recommendations for tapering biological therapy for psoriasis. These recommendations provide scientific support for dermatologists and healthcare providers regarding criteria for tapering, strategies and regimens, monitoring, failure management, and considerations for implementation.

Conclusion: Tapering of biologics appears to be effective and safe in psoriasis patients with low stable activity or clinical remission. This Latin American consensus was developed in recognition of the need for rational and optimal use of biologics, while individualizing cases to apply best clinical practices.

KEYWORDS
Biological therapy; Consensus; Delphi technique; Drug tapering; Latin America; Psoriasis

General principles

The decision to taper biologic agents in psoriasis must weigh benefits and risks through an individualized assessment of each patient.
Each patient evaluation should be based on disease severity, presence of comorbidities, quality of life, and patient values and preferences.
The statements generated from this consensus serve as suggested practice recommendations without constituting a restrictive care guideline for patients with psoriasis.
Particularly in the Latin American context, it is important to consider the realities of the specific clinical setting and the availability of resources when implementing the recommendations.

Statements	Agreement	level
Tapering of biological therapy may be considered in patients with psoriasis who achieve and maintain the	100%
therapeutic goal of a sustained PASI100, PASI/BSA/PGA 0, for at least one year.
Tapering of biological therapy may be considered in patients with psoriasis who achieve and maintain an	67%a
absolute PASI < 3 for at least one year, according to individual clinical characteristics and in consultation
with the patient.
Tapering of biological therapy may be considered in patients with psoriasis involving specific areas with	87%
complete or almost complete improvement (PGA 0-1 ) for at least one year.
Tapering of biologic therapy may be considered in patients with mild psoriasis, good general health, a low	88%
initial PASI score, a good response to biologic treatment, and a short time to clinical remission.
When considering tapering of biologic therapy, health-related quality of life should be taken into account,	94%
as it may deteriorate significantly during treatment interruption.

Statements	Agreement	level
In patients with psoriasis who have achieved and maintained a therapeutic response, tapering of biological	92%
therapy aims to maintain the established goal while using the lowest possible effective dose.
Tapering strategies include gradually increasing the intervals between administrations and reducing the	92%
dose for those medications that allow it.
Biologic dosage regimen should allow for flexible dose modification (increasing the interval or reducing the	82%
dose).
The tapering regimen should be based on the indications for each biologic, its dosing intervals and dose	100%
adjustment options (see Table 4).

Biological	Standard Dosage	Initial Tapering Regimen	Extended Tapering Regimena
Adalimumab	40 mg every 2-weeks	40 mg every 4-weeks	Then, every 6-weeks
Etanercept	50 mg every week	50 mg every 14-days	Up to 21-day interval
Infliximab	3 or 5 mg/kg every 8-weeks	Do not taper due to
		associated risks; prefer
		switching
Ustekinumabb	45 mg (≤100 kg) every 12-weeks 90 mg (>100 kg) every	45 mg every 16-weeks 90 mg every 16-weeks	Up to 24-week interval Up to 24-week interval
	12-weeks	45 mg every 12-weeks	45 mg every 16-weeks
Secukinumabc	300 mg every 4-weeks	300 mg every 6-weeks	Up to 8-week interval
		150 mg every 4-weeks	Up to 6-week interval
Guselkumab	100 mg every 8-weeks	100 mg every 12-weeks	Up to interval every 16 weeks
Risankizumab	150 mg every 12-weeks	150 mg every 16-weeks	Until interval every 24-weeks
Certolizumab pegol	200 mg every 2-weeks	200 mg every 4 weeks	200 mg every 6-weeks
Ixekizumab	80 mg every 4-weeks	80 mg every 6-weeks	80 mg every 8 weeks

Statements	Agreement	level
Patients undergoing tapering of biological therapy should be followed up every 3-months, or sooner if	100%
there is a worsening of symptoms (skin or joint) or any other situation that warrants it.
The identification of any of the following criteria at any time during follow-up is considered a failure of
the tapering strategy:
Absolute PASI >3	100%
PGA/BSA >1	93%
Unacceptable increase in disease activity as judged by the patient	100%
Change in morphology (e.g., psoriasis with pustules)	93%
Reactivation or appearance of lesions in specific areas	100%
Onset of joint symptoms	100%
In the event of a relapse with PASI ≥ 10 in a patient with psoriasis undergoing tapering of biologic therapy,	100%
the induction dose of the biologic should be restarted.
In the event of a relapse with PASI < 10 in a patient with psoriasis undergoing tapering of biologic therapy,	100%
the immediately previous effective dose of biologic therapy should be reinstated.

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Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

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[1] PASI, Psoriasis Area Severity Index; PGA, Physician Global Assessment; BSA, Body Surface Area.

[TFN1] ^a
Unanimous agreement was not possible.

Latin American consensus on tapering of biological therapy in psoriasis*

Abstract

Latin American consensus on tapering of biological therapy in psoriasis^*