Maintenance Therapy in Psoriasis After Biologic Discontinuation

Abstract

Introduction: Biologic agents for psoriasis are often discontinued after remission due to cost or adverse events. This review identifies predictors of relapse-free survival after withdrawal. Methods: Twelve prospective cohort studies (n=1,204 psoriasis patients) with ≥12 months follow-up after discontinuing TNF-α, IL-17, or IL-23 inhibitors. Results: Median time to relapse (PASI >5) was 6 months for TNF inhibitors, 9 months for IL-17 inhibitors, and 14 months for IL-23 inhibitors. Predictors of prolonged remission: high-quality initial response (≥PASI 90), low BMI, and concurrent methotrexate. Discussion: IL-23 inhibitors produce more durable remission, possibly due to resetting of memory T-cell populations. Most studies were observational with no washout randomization. Conclusions: IL-23 inhibitors are preferred when long drug holidays are desired, but all patients eventually relapse. Maintenance topical therapy prolongs remission.