{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:08:25Z","timestamp":1793920105843,"version":"4.8.0"},"reference-count":22,"publisher":"Mattioli1885","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Chronic plaque psoriasis is commonly treated with IL-17 and IL-23 inhibitors, which are highly effective but associated with substantial costs. Because many patients achieve long-term disease control, fixed-dose regimens may result in overtreatment. Objectives: This study assessed the economic impact of disease-activity-guided dose reduction (DR) strategies using secukinumab, brodalumab, guselkumab, and risankizumab in adults with stable plaque psoriasis. Methods: This cost analysis was based on data from the PSORED trial, a multicenter prospective open-label study conducted in Piedmont, Italy (2023\u20132025). Patients with stable disease (PASI \u22643, DLQI \u22643 for \u22659 months) underwent DR trough a 1.5x extension of maintenance dosing intervals. Costs under DR and standard dosing (SD) were compared over 52 weeks using Italian tariff data and real-world treatment patterns. Results: Among 156 enrolled patients, 39 discontinued DR, 38 returned to standard dosing, and one switched therapy. DR reduced biologics consumption without increasing follow-up requirements, yielding a 26% decrease in total costs and an average annual saving of \u20ac7,303.57 per patient. Conclusions: DR was both clinically effective and cost-saving, maintaining disease control without major safety concerns. These findings support the implementation of DR strategies in routine clinical practice to enhance long-term sustainability while preserving therapeutic efficacy.<\/jats:p>","DOI":"10.5826\/dpc.1603a6747","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:08:10Z","timestamp":1785510490000},"page":"6747","source":"Crossref","is-referenced-by-count":1,"title":["Less Is More: Cost-Effective Psoriasis Management via Disease-Driven Dosing of IL-17\/IL-23 Inhibitors"],"prefix":"10.5826","volume":"16","author":[{"given":"Edoardo","family":"Cammarata","sequence":"first","affiliation":[{"name":"SCDU Dermatologia, AOU Maggiore della Carit\u00e0, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Airoldi","sequence":"additional","affiliation":[{"name":"SCDU Dermatologia, AOU Maggiore della Carit\u00e0, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, AOU Maggiore della Carit\u00e0, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrealuna","family":"Ucciero","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, AOU Maggiore della Carit\u00e0, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Mastorino","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, Department of Clinical Medicine, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Arese","sequence":"additional","affiliation":[{"name":"SSD Dermatologia, AO Santa Croce e Carle Hospital, Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Burzi","sequence":"additional","affiliation":[{"name":"SS Dermatologia, AOU SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Castelli","sequence":"additional","affiliation":[{"name":"UO Dermatologia, Ospedale Koelliker, 10024 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Chiarpenello","sequence":"additional","affiliation":[{"name":"SSD Dermatologia, AO Santa Croce e Carle Hospital, Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Graziola","sequence":"additional","affiliation":[{"name":"SSD Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Leporati","sequence":"additional","affiliation":[{"name":"SS Dermatologia, AOU SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Ortoncelli","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, Department of Clinical Medicine, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Pella","sequence":"additional","affiliation":[{"name":"SSD Dermatologia, Ospedale degli Infermi, 13875 Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ginevra","family":"Pertusi","sequence":"additional","affiliation":[{"name":"SC Dermatologia, S. Andrea Hospital, ASL Vercelli, Vercelli"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Quaglino","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, Department of Clinical Medicine, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ribero","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, Department of Clinical Medicine, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Rossotto","sequence":"additional","affiliation":[{"name":"SSD Dermatologia, Cardinal Massaia Hospital, Asti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Pisterna","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, AOU Maggiore della Carit\u00e0, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Tiberio","sequence":"additional","affiliation":[{"name":"SC Dermatologia, S. Andrea Hospital, ASL Vercelli, Vercelli"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Dapavo","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, Department of Clinical Medicine, University of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Savoia","sequence":"additional","affiliation":[{"name":"Department of Health Science, University of Eastern Piedmont, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27750","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"10.5826\/dpc.1603a6747_ref1","doi-asserted-by":"crossref","unstructured":"Nast A, Smith C, Spuls PI, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol. 2020;34(11):2461-2498. DOI: 10.1111\/jdv.16916.","DOI":"10.1111\/jdv.16915"},{"key":"10.5826\/dpc.1603a6747_ref2","doi-asserted-by":"crossref","unstructured":"Gisondi P, Fargnoli MC, Amerio P, et al. Italian adaptation of EuroGuiDerm guideline on the systemic treatment of chronic plaque psoriasis. Ital J Dermatol Venerol. 2022;157:1-78. DOI: 10.23736\/S2784-8671.21.07119-2.","DOI":"10.23736\/S2784-8671.21.07132-2"},{"key":"10.5826\/dpc.1603a6747_ref3","doi-asserted-by":"crossref","unstructured":"Menter A, Krueger GG, Paek SY, et al. Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities. Dermatol Ther (Heidelb). 2021;11:385\u2013400. DOI: 10.1007\/s13555-021-00523-y.","DOI":"10.1007\/s13555-021-00483-2"},{"key":"10.5826\/dpc.1603a6747_ref4","doi-asserted-by":"crossref","unstructured":"Amatore F, Villani AP, Tauber M, et al. French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults. J Eur Acad Dermatol Venereol. 2019;33(3):464-483. DOI: 10.1111\/jdv.15372.","DOI":"10.1111\/jdv.15340"},{"key":"10.5826\/dpc.1603a6747_ref5","doi-asserted-by":"crossref","unstructured":"van der Schoot LS, van den Reek JMPA, Grine L, et al. Dose reduction of the new generation biologics (IL-17 and IL-23 inhibitors) in psoriasis: study protocol for an international, pragmatic, multicenter, randomized, controlled, non-inferiority study-the BeNeBio study. Trials. 2021;22(1):707. DOI: 10.1186\/s13063-021-05634-9.","DOI":"10.1186\/s13063-021-05681-z"},{"key":"10.5826\/dpc.1603a6747_ref6","doi-asserted-by":"crossref","unstructured":"Atalay S, van den Reek JMPA, den Broeder AA, et al. Comparison of Tightly Controlled Dose Reduction of Biologics With Usual Care for Patients With Psoriasis: A Randomized Clinical Trial. JAMA Dermatol. 2020;156(4):393-400. DOI: 10.1001\/jamadermatol.2019.4627.","DOI":"10.1001\/jamadermatol.2019.4897"},{"key":"10.5826\/dpc.1603a6747_ref7","doi-asserted-by":"crossref","unstructured":"Atalay S, van der Schoot LS, Vandermaesen L, et al. Evaluation of a One-step Dose Reduction Strategy of Adalimumab, Etanercept and Ustekinumab in Patients with Psoriasis in Daily Practice. Acta Derm Venereol. 2021;101(5):adv00463. DOI: 10.2340\/00015555-3810.","DOI":"10.2340\/00015555-3815"},{"key":"10.5826\/dpc.1603a6747_ref8","doi-asserted-by":"crossref","unstructured":"Daud\u00e9n E, Escario E, Martos-Cabrera L, et al. Dose reduction is a feasible strategy in patients with plaque psoriasis who achieve sustained response with secukinumab: a retrospective, multicenter cohort study in daily practice setting. Int J Dermatol. 2024;63(4):503-511. DOI: 10.1111\/ijd.17066.","DOI":"10.1111\/ijd.16915"},{"key":"10.5826\/dpc.1603a6747_ref9","doi-asserted-by":"crossref","unstructured":"Cammarata E, Airoldi C, Colombo J, et al. Impact of Disease Activity-Guided Dose Reduction on IL-17 and IL-23 Inhibitors in Psoriasis: A Real-World Assessment of Efficacy, Safety, and Economic Benefits. Dermatol Pract Concept. 2024;14(3):5845. DOI: 10.5826\/dpc.1403a45. PMID: 38784177.","DOI":"10.5826\/dpc.1503a5845"},{"key":"10.5826\/dpc.1603a6747_ref10","doi-asserted-by":"crossref","unstructured":"Eyerich K, Asadullah K, Pinter A, et al. Noninferiority of 16-Week vs 8-Week Guselkumab Dosing in Super Responders for Maintaining Control of Psoriasis: The GUIDE Randomized Clinical Trial. JAMA Dermatol. 2024;160(9):953\u2013963. DOI: 10.1001\/jamadermatol.2024.2383.","DOI":"10.1001\/jamadermatol.2024.2463"},{"key":"10.5826\/dpc.1603a6747_ref11","doi-asserted-by":"crossref","unstructured":"Reich K, Puig L, Szepietowski JC, et al. Secukinumab dosing optimization in patients with moderate-to-severe plaque psoriasis: results from the randomized, open-label OPTIMISE study. Br J Dermatol. 2020;182(2):304-315. DOI: 10.1111\/bjd.18378.","DOI":"10.1111\/bjd.18143"},{"key":"10.5826\/dpc.1603a6747_ref12","doi-asserted-by":"crossref","unstructured":"Baniandr\u00e9s O, Rodr\u00edguez-Soria VJ, Romero-Jim\u00e9nez RM, Su\u00e1rez R. Dose Modification in Biologic Therapy for Moderate to Severe Psoriasis: A Descriptive Analysis in a Clinical Practice Setting. Actas Dermosifiliogr. 2015;106(7):569-77. DOI: 10.1016\/j.ad.2015.04.017.","DOI":"10.1016\/j.adengl.2015.06.004"},{"key":"10.5826\/dpc.1603a6747_ref13","doi-asserted-by":"crossref","unstructured":"Blauvelt A, Ferris LK, Yamauchi PS, et al. Extension of ustekinumab maintenance dosing interval in moderate-to-severe psoriasis: results of a phase IIIb, randomized, double-blinded, active-controlled, multicentre study (PSTELLAR). Br J Dermatol. 2017;177(6):1552-1561. DOI: 10.1111\/bjd.15655.","DOI":"10.1111\/bjd.15722"},{"key":"10.5826\/dpc.1603a6747_ref14","doi-asserted-by":"crossref","unstructured":"Atalay S, van den Reek JMPA, Otero ME, et al. Health Economic Consequences of a Tightly Controlled Dose Reduction Strategy for Adalimumab, Etanercept and Ustekinumab Compared with Standard Psoriasis Care: A Cost-utility Analysis of the CONDOR Study. Acta Derm Venereol. 2020;100(19):adv00340. DOI: 10.2340\/00015555-3642.","DOI":"10.2340\/00015555-3692"},{"key":"10.5826\/dpc.1603a6747_ref15","doi-asserted-by":"crossref","unstructured":"Atalay S, van den Reek JMPA, Groenewoud JMM, et al. Two-year follow-up of a dose reduction strategy trial of biologics adalimumab, etanercept, and ustekinumab in psoriasis patients in daily practice. J Dermatolog Treat. 2022;33(3):1591-1597. DOI: 10.1080\/09546634.2021.1906963.","DOI":"10.1080\/09546634.2020.1869147"},{"key":"10.5826\/dpc.1603a6747_ref16","doi-asserted-by":"crossref","unstructured":"Benzaquen M, Munshi M, Bossart S, et al. Long-Term Dose Optimization of Adalimumab via Dose Spacing in Patients with Psoriasis. Bioengineering (Basel). 2022;9(8):387. DOI: 10.3390\/bioengineering9080387.","DOI":"10.3390\/bioengineering9080387"},{"key":"10.5826\/dpc.1603a6747_ref17","doi-asserted-by":"crossref","unstructured":"Gisondi P, Maurelli M, Bellinato F, Girolomoni G. Is risankizumab as needed administration a good option for patients with plaque psoriasis? J Eur Acad Dermatol Venereol. 2022;36(9):e713-e715. DOI: 10.1111\/jdv.18182.","DOI":"10.1111\/jdv.18182"},{"key":"10.5826\/dpc.1603a6747_ref18","doi-asserted-by":"crossref","unstructured":"Papp K, Leonardi C, Menter A, et al. Safety and efficacy of brodalumab for psoriasis after 120 weeks of treatment. J Am Acad Dermatol. 2014;71(6):1183-1190.e3. DOI: 10.1016\/j.jaad.2014.07.039.","DOI":"10.1016\/j.jaad.2014.08.039"},{"key":"10.5826\/dpc.1603a6747_ref19","doi-asserted-by":"crossref","unstructured":"Armstrong AW, Robertson AD, Wu J, et al. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149(10):1180-5. DOI: 10.1001\/jamadermatol.2013.5289.","DOI":"10.1001\/jamadermatol.2013.5264"},{"key":"10.5826\/dpc.1603a6747_ref20","doi-asserted-by":"crossref","unstructured":"Veronese F, Graziola F, Cammarata E, et al. The Diagnostic-Therapeutic Care Pathway in Psoriasis: Towards ISO 9001:2015 Certification. Medicina (Kaunas). 2020;56(5):253. DOI: 10.3390\/medicina56050253.","DOI":"10.3390\/medicina56050253"},{"key":"10.5826\/dpc.1603a6747_ref21","doi-asserted-by":"crossref","unstructured":"Terui H, Asano Y. Biologics for Reducing Cardiovascular Risk in Psoriasis Patients. J Clin Med. 2023;12(3):1162. DOI: 10.3390\/jcm12031162.","DOI":"10.3390\/jcm12031162"},{"key":"10.5826\/dpc.1603a6747_ref22","doi-asserted-by":"crossref","unstructured":"Thomas SE, Barenbrug L, Hannink G, et al. Drug Survival of IL-17 and IL-23 Inhibitors for Psoriasis: A Systematic Review and Meta-Analysis. Drugs. 2024;84(5):565-578. DOI: 10.1007\/s40265-024-02022-7.","DOI":"10.1007\/s40265-024-02028-1"}],"container-title":["Dermatology Practical &amp; Conceptual"],"original-title":[],"link":[{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/download\/6747\/3954","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/download\/6747\/3954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T12:02:06Z","timestamp":1788264126000},"score":1,"resource":{"primary":{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/view\/6747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.5826\/dpc.1603a6747","relation":{"has-manifestation":[{"id-type":"other","id":"1-84-6747-g3954","asserted-by":"subject"}],"is-part-of":[{"id-type":"doi","id":"10.5826\/dpc.1603a%a","asserted-by":"subject"}]},"ISSN":["2160-9381"],"issn-type":[{"value":"2160-9381","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"3"}}