Many psoriasis patients do not achieve complete skin clearance with biologic monotherapy. In a study, researchers assessed treatment approaches for patients who fail to achieve complete clearance from their biologic. They modeled the efficacy, cost, and safety of three treatment approaches: (1) adding a topical agent to their biologic, (2) escalating the biologic dose, and (3) switching to a different biologic. The study found that adding a topical agent may be an efficacious, low-cost, and safe approach for this patient population. The results of the study were published as part of the American Academy of Dermatology Virtual Meeting Experience 2020.
Researchers conducted a systematic review of Medline to identify articles assessing treatment approaches for moderate-to-severe plaque psoriasis in patients who failed to achieve complete skin clearance on biologic therapy. Researchers defined complete clearance as 100% improvement in Psoriasis Area and Severity Index and/or Physician’s Global Assessment score of clear. Researchers used wholesale acquisition cost from Medi-Span Price Rx to determine the cost of each treatment.
Specifically, they assessed the following treatment approaches: ixekizumab dose escalation, ustekinumab dose escalation, adalimumab dose escalation, guselkumab dose escalation, switching to guselkumab, switching to infliximab, and adding calcipotriene/betamethasone foam.
Among patients who were not clear after initial biologic treatment, complete clearance occurred with the addition calcipotriene/betamethasone dipropionate foam in 28% of patients, after switching to guselkumab in 20% of patients, and after switching to infliximab in 15.8% of patients.
Adding calcipotriene/betamethasone dipropionate foam to the initial biologic ($3,780 per additional patient cleared) was a less costly approach compared with the lowest cost dose escalation (guselkumab, $73,370 per additional patient cleared) or switching the initial failed biologic to the lowest cost alternative biologic (infliximab, $88,250 per additional patient cleared). No treatment-related or serious adverse events were observed after adding calcipotriene/betamethasone foam.
Haidari W, Pona A, Feldman SR. Efficacy, Cost, and Safety of Three Treatment Approaches to Managing Residual Psoriasis in Patients on Biologic Therapy. Presented during the AAD Virtual Meeting Experience 2020, June 12-14, 2020.