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Introduction <p>Psoriasis is a chronic inflammatory disease that often requires long-term treatment. However, treatment interruption is common. Although several predictors of drug-free remission (DFR) have been reported, the impact of treatment duration remains unclear. In Taiwan, biologics were reimbursed for up to 2.5&#xa0;years, with re-treatment initiated after relapse. This study compared DFR between reimbursed patients and those enrolled in phase&#xa0;III pivotal trials, where treatment courses were at least 4&#xa0;years.</p> Methods <p>This two-center, retrospective study included patients with moderate-to-severe plaque psoriasis treated with secukinumab, guselkumab, or risankizumab. For reimbursement, patients were required to have Psoriasis Area and Severity Index (PASI) ≥ 10, whereas pivotal trials required PASI ≥ 12 and body surface area ≥ 10%. Patients were classified into short-term (≤ 2.5&#xa0;years, reimbursed) and long-term (4–6&#xa0;years, clinical trials) treatment groups. Disease relapse was assessed at each visit, and DFR was evaluated using Kaplan–Meier analysis and Cox regression.</p> Results <p>Among 164 patients, 51 received long-term therapy and 113 received short-term therapy. Long-term therapy was associated with longer DFR (median 211 vs. 111&#xa0;days, log-rank <i>p</i> &lt; 0.001). In multivariate analysis, long-term risankizumab reduced relapse risk by 66% (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.13–0.90, <i>p</i> = 0.03), with a non-significant trend for long-term guselkumab (HR 0.55, 95%&#xa0;CI 0.28–1.06, <i>p</i> = 0.07). In contrast, no significant difference was observed for secukinumab (log-rank <i>p</i> = 0.94). In the guselkumab subgroup, continuous long-term therapy resulted in numerically higher remission days per dose than interrupted sequential short-term therapy (9.61 ± 11.43 vs. 8.23 ± 2.78, <i>p</i> = 0.64).</p> Conclusion <p>Long-term treatment with interleukin (IL)-23 inhibitors (particularly risankizumab), but not anti-IL-17 inhibitors, may prolong DFR, suggesting a potential disease-modifying effect of prolonged IL-23 inhibition. These findings should be considered preliminary and warrant confirmation in larger prospective studies.</p>

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Impact of Biologic Treatment Duration on Drug-Free Remission in Moderate-to-Severe Psoriasis: A Retrospective Cohort Study

  • 期刊论文

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  • 发表日期：

    2026年5月27日

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  • Che-Chia Hsu,
  • Yu-Huei Huang,
  • Tsen-Fang Tsai

摘要

Introduction

Psoriasis is a chronic inflammatory disease that often requires long-term treatment. However, treatment interruption is common. Although several predictors of drug-free remission (DFR) have been reported, the impact of treatment duration remains unclear. In Taiwan, biologics were reimbursed for up to 2.5 years, with re-treatment initiated after relapse. This study compared DFR between reimbursed patients and those enrolled in phase III pivotal trials, where treatment courses were at least 4 years.

Methods

This two-center, retrospective study included patients with moderate-to-severe plaque psoriasis treated with secukinumab, guselkumab, or risankizumab. For reimbursement, patients were required to have Psoriasis Area and Severity Index (PASI) ≥ 10, whereas pivotal trials required PASI ≥ 12 and body surface area ≥ 10%. Patients were classified into short-term (≤ 2.5 years, reimbursed) and long-term (4–6 years, clinical trials) treatment groups. Disease relapse was assessed at each visit, and DFR was evaluated using Kaplan–Meier analysis and Cox regression.

Results

Among 164 patients, 51 received long-term therapy and 113 received short-term therapy. Long-term therapy was associated with longer DFR (median 211 vs. 111 days, log-rank p < 0.001). In multivariate analysis, long-term risankizumab reduced relapse risk by 66% (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.13–0.90, p = 0.03), with a non-significant trend for long-term guselkumab (HR 0.55, 95% CI 0.28–1.06, p = 0.07). In contrast, no significant difference was observed for secukinumab (log-rank p = 0.94). In the guselkumab subgroup, continuous long-term therapy resulted in numerically higher remission days per dose than interrupted sequential short-term therapy (9.61 ± 11.43 vs. 8.23 ± 2.78, p = 0.64).

Conclusion

Long-term treatment with interleukin (IL)-23 inhibitors (particularly risankizumab), but not anti-IL-17 inhibitors, may prolong DFR, suggesting a potential disease-modifying effect of prolonged IL-23 inhibition. These findings should be considered preliminary and warrant confirmation in larger prospective studies.