From the Research
The current rates of deprescribing in patients with psoriasis are not well-established in the medical literature, with limited systematic data available on this specific practice. Deprescribing, which involves the planned and supervised process of dose reduction or stopping of medications that may no longer be beneficial or may cause harm, appears to be inconsistently implemented in psoriasis management. While treatment de-escalation is sometimes practiced for biologics like adalimumab, etanercept, and ustekinumab after achieving disease control, specific rates vary widely across different healthcare settings and countries. Factors influencing deprescribing decisions include disease severity reduction, medication side effects, patient preference, cost considerations, and comorbidity management.
The process typically involves gradual dose reduction rather than abrupt discontinuation, with careful monitoring for disease flares. Clinicians managing psoriasis patients should consider regular medication reviews, particularly for those on multiple therapies or long-term systemic treatments, to identify opportunities for appropriate deprescribing while maintaining disease control and quality of life. According to a study published in 2019 1, new users of apremilast, etanercept, and ustekinumab had a decreased rate of serious infection compared with methotrexate, which may inform deprescribing decisions.
Some key points to consider in deprescribing for psoriasis patients include:
- Disease severity reduction: Patients with well-controlled disease may be candidates for deprescribing.
- Medication side effects: Patients experiencing adverse effects from their medications may benefit from deprescribing.
- Patient preference: Patient values and preferences should be taken into account when making deprescribing decisions.
- Cost considerations: The cost of medications can be a significant burden for patients, and deprescribing may help reduce this burden.
- Comorbidity management: Patients with multiple comorbidities may require careful consideration of their medication regimen to minimize potential interactions and adverse effects.
A network meta-analysis published in 2017 2 compared the efficacy and safety of various systemic treatments for psoriasis, including biologics and conventional systemic agents. The analysis found that biologic treatments, such as ixekizumab, secukinumab, and ustekinumab, were significantly more effective than conventional systemic agents in achieving PASI 90, a measure of disease severity. However, the analysis also noted that the evidence for deprescribing in psoriasis is limited, and further research is needed to inform deprescribing decisions.
In terms of future research, studies should focus on comparing the efficacy and safety of different treatments, including head-to-head trials and subgroup analyses, to provide more informed deprescribing decisions. Additionally, outcome measure harmonization is needed in psoriasis trials to ensure consistent reporting of results. By prioritizing patient-centered care and considering the complex factors involved in deprescribing, clinicians can make informed decisions that balance the benefits and risks of treatment for patients with psoriasis.