Extending IL-23 Inhibitor Dosing Schedules in Psoriasis

Alleviate Treatment Burden and Reduce Costs

There is a subgroup of patients with psoriasis being treated with IL-23 inhibitors, such as guselkumab and risankizumab, for whom it is possible to extend the dose administration without compromising clinical efficacy. While on-label dosing regimens involve injections every 8 or 12 weeks, a considerable number of patients may successfully extend their dose administration intervals to 12 or even 16 weeks for guselkumab and 20 or even 24 weeks for risankizumab.

I found in my clinical practice that the most suitable candidates for extended dosing are those achieving complete skin clearance (Psoriasis Area and Severity Index, body surface area, or Physician Global Assessment = 0) for a duration of at least 6 to 9 months. These patients are more likely to maintain complete skin clearance even after the extension of the dose administration. Additionally, an on-demand administration strategy, with doses administered when clinical symptoms or signs begin to reappear, has also proven to be an option.

The rationale behind extending the dosing schedule lies in the sustained suppression of IL-23-mediated inflammatory pathways, potentially preventing the recurrence of psoriatic lesions, probably by influencing tissue resident memory and regulatory T-cell mechanisms. Incorporating extended dosing intervals for IL-23 inhibitors in psoriasis management aligns with the growing emphasis on personalized medicine and patient-centered care, representing a promising avenue in the pursuit of optimizing treatment outcomes for individuals with psoriasis being treated with IL-23 inhibitors. Notably, it not only alleviates the treatment burden on patients, but also holds the potential to reduce health care costs and resource utilization.

Tiago Torres, MD, PhD
Porto, Portugal

Have an Anecdote

I have come to believe that one anecdote is more convincing than all the data. I like to tell patients, “I had another patient. You remind me of them, and your rash is so similar. They did great on drug X. I think that is a good choice for you.”

Steven R. Feldman, MD, PhD
Winston-Salem, NC

Be More Than a Cosmetic

Provider If a cosmetic patient has arthritis, back pain, or other medical is- sues, I always offer to refer them to a specialist. They greatly ap- preciate my caring for their overall health and not just their beauty. Similarly, I have spotted many an actinic keratosis or basal cell car- cinoma on the face, or managed their acne or perioral dermatitis, without asking them to rebook or get a referral. They are less likely to explore a med spa closer to their home or with better hours or lower prices because they know that I am not only keeping them young and beautiful, but also truly care about their overall health.

Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada

© 2024 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.