National consensus on biologic dose reduction in psoriasis: a modified eDelphi procedure

Abstract

Background

Dose reduction of biologics for psoriasis is applied in daily practice, although guidelines are lacking. Striving for clear criteria is important, as it leads to a consistent application of dose reduction.

Objective

To achieve consensus on criteria for biologic dose reduction in psoriasis patients with stable and low disease activity.

Methods

An online Delphi procedure (eDelphi) was conducted. Dutch dermatologists were invited to participate in a maximum of 3 voting rounds. Proposed statements were selected based on literature review and included criteria for the application of dose reduction and dosing schedules. Biologic dose reduction was defined as ‘application of injection interval prolongation’. Proposed statements were rated using a 9-point Likert scale; consensus was reached when ≥70% of all voters rated ‘agree’ (7–9) and <15% rated ‘disagree’ (1–3).

Results

A total of 27 dermatologists participated and reached a consensus on 15 recommendations over 2 voting rounds. Agreed statements included criteria for dose reduction eligibility, criteria for dose reduction (dis)continuation, and dosing schedules for adalimumab, etanercept, and ustekinumab. Based on the eDelphi outcomes, an algorithm fit for implementation in current practice was developed.

Conclusions

Recommendations of this national consensus process can guide clinicians, and consequently their patients, toward consistent application of biologic dose reduction.

Keywords:

• Biologics
• consensus
• dose reduction
• eDelphi
• psoriasis

Acknowledgments

The authors acknowledge the key role played by the Dutch Association for Dermatology and Venereology in the organization of the eDelphi survey and would like to thank the Dutch National Psoriasis Patient Association for their contributions. The authors would also like to thank all participating dermatologists who took part in the eDelphi rounds, among them: M. B. A. van Doorn, P. I. Spuls, M. P. M. Andriessen, D. Vellinga, M. de Groot, S. R. P. Dodemont, A. L. Nguyen, E. A. Dowlatshahi, R. R. Keijsers, D. N. H. Enomoto, L. A. A. Gerbens, S. van de Scheur, M. A. de Rie, P. P. M. van Lumig, J. H. J. Hendricksen-Roelofzen, E. T. Hamers. All those named have given their consent to be acknowledged.

Disclosure statement

L. S. van der Schoot carries out clinical trials for Janssen and Novartis and received speaking fees from Janssen and Eli Lilly. All funding is not personal but goes to the independent Research Fund of the Department of Dermatology of the Radboud University Medical Center Nijmegen, The Netherlands. E. M. Baerveldt received speaking fees from Abbvie, Janssen, and Novartis and attended advisory boards from Janssen. Fees were paid directly to the institution. M. M. B. Seyger received grants from/was involved in clinical trials from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, Leo Pharma, and Pfizer. She served as a consultant for Abbvie, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, and UCB. Fees were paid directly to the institution. S. L. Wanders received speaking fees from Abbvie. Fees were paid directly to the institution. J. M. P. A. van den Reek carries out clinical trials for AbbVie, Celgene, and Janssen; has received speaking fees/attended advisory boards from AbbVie, BMS, Almirall and Janssen and has received reimbursement for attending a symposium from Celgene and AbbVie. All funding is not personal but goes to the independent research fund of the Department of Dermatology of the Radboud University Medical Center Nijmegen, the Netherlands. E. M.G. J. de Jong has received research grants for the independent research fund of the Department of Dermatology of the Radboud University Medical Center Nijmegen, the Netherlands from AbbVie, Pfizer, Novartis, Janssen Pharmaceuticals and Leo Pharma, and has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including AbbVie, Janssen Pharmaceuticals, Novartis, Lily, Celgene, Leo Pharma, UCB and Almirall. All funding is not personal but goes to the independent research fund of the Department of Dermatology of the Radboud University Medical Center Nijmegen, the Netherlands. The other authors declare no conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

The present work was financially supported by ZonMw, the Hague, the Netherlands.