Psoriasis Not Reaching PASI 75 After Biologic Dose Escalation and Add-On Therapies
In moderate-to-severe psoriasis, treatment is guided by a measurable clearance target. When a biologic-based regimen — even after augmentation — still falls short of that goal, a defined next step is supported by evidence.
Despite escalating the biologic dose or increasing its dosing frequency, and/or adding further agents such as topical high-potency corticosteroids (with or without a vitamin D analogue), methotrexate, acitretin, apremilast, or narrowband ultraviolet B phototherapy, the clinical target of PASI 75 (75% improvement in the Psoriasis Area Severity Index) was not achieved.
The target remains 75% improvement in the Psoriasis Area Severity Index (PASI 75).
After failure of biologic escalation and add-on therapy, the evidence-based approach centres on switching to a different biologic agent. The complete structured regimen — including which agent, how it is selected, and the monitoring framework — is in the full protocol.
References
DOI: 10.1016/j.jaad.2018.11.057
If clinically needed, all other therapies for psoriasis, including other biologics, may be switched with a different biologic agent with the possibility of improved efficacy, safety, and/or tolerability.
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