International Panel Agrees on Framework for Tapering Psoriasis Biologics

Dermatologists worldwide already taper biologic doses in patients with well-controlled psoriasis, just without a shared playbook for when or how, a gap a new international consensus published in the Journal of the European Academy of Dermatology and Venereology aims to close.¹

A Practice Ahead of Its Guidelines

Dose reduction of biologics in patients with psoriasis is already applied in routine clinical practice, often informally, but without clear guidelines standardizing when to consider it, how to execute it, or when to reverse course if disease activity returns. Dermatologists worldwide have identified this gap as a priority for guidance, particularly as tapering strategies elsewhere in rheumatology and dermatology (including a parallel Latin American consensus on biologic tapering in psoriasis) have begun to formalize similar approaches regionally.²

An international steering committee set out to build consensus across a broader, global panel of dermatologists on dose reduction of biologics in adult patients with psoriasis, aiming to translate existing but scattered practice patterns into a structured, internationally applicable framework.¹

A Modified eDelphi Across 6 Continents

The international, modified eDelphi consensus study began with 11 statements on biologic dose reduction, generated by the steering committee based on a prior literature review. Invitations were distributed through international dermatological societies, and participants rated their agreement with each statement on a 9-point Likert scale across up to 3 consensus rounds plus 1 digital consensus meeting. A statement reached consensus if at least 70% of participants agreed and fewer than 15% disagreed; statements that did not meet that threshold were revised for the next round.

In total, 62 dermatologists from Europe, South America, Asia, North America, Africa, and Australia completed the eDelphi process. After the first round, 9 of the 11 statements reached consensus. The remaining 2 were revised and reached consensus in the second round. Participants agreed on criteria for when to consider, initiate, continue, or discontinue dose reduction, and on a 2-step dose-reduction algorithm specifically for adalimumab, etanercept, and ustekinumab. They further agreed that the same 2-step strategy could reasonably be considered for interleukin-17 and interleukin-23 inhibitors, while acknowledging that scientific evidence supporting dose reduction for these newer biologic classes remains more limited than for the older agents.

“This first international consensus provides essential information for uptake and implementation of biologic dose reduction for psoriasis on a global scale,” the authors wrote.

Consensus, Not a Randomized Comparison

As a Delphi consensus exercise rather than a clinical trial, the agreed-upon criteria and algorithm reflect expert opinion rather than prospectively tested outcomes data, meaning real-world implementation will still require validation of how patients fare under the proposed tapering approach.

The extension of the 2-step strategy to interleukin-17 and interleukin-23 inhibitors was explicitly qualified by the panel as provisional, given the comparatively thin evidence base for dose reduction with these newer drug classes relative to adalimumab, etanercept, and ustekinumab.

For payers increasingly interested in cost-conscious biologic management and for dermatologists fielding patient interest in lower-dose regimens, the consensus offers the first internationally vetted starting point for structured dose reduction, though formal outcomes studies, particularly for newer interleukin-17 and interleukin-23 inhibitors, will be needed before the approach can be considered fully evidence-based.

References

1. van Riel CAM, Boehncke WH, Lambert JLW, et al. International consensus on dose reduction of biologics for patients with psoriasis: The DR. Delphi study. J Eur Acad Dermatol Venereol. 2026;40(9):1449-1459. doi:10.1111/jdv.70447
2. Londoño-García AM, Castro-Ayarza JR, Franco Franco MD, et al. Latin American consensus on tapering of biological therapy in psoriasis. An Bras Dermatol. 2025;100(4):501134. doi:10.1016/j.abd.2025.501134