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Psoriasis — SCE Dermatology MCQ

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ModerateDermatopharmacologyPsoriasisSCE Dermatology

A 55-year-old man with severe plaque psoriasis has been on Adalimumab for 4 years with excellent response. He is now in sustained remission with PASI 0. Can treatment be de-escalated or stopped?

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Correct answer: E — Consider dose interval extension or supervised withdrawal with close monitoring

For patients on biologic therapy achieving sustained remission, dose interval extension (tapering) may be considered per BAD guidelines. Some patients maintain remission with extended dosing intervals (e.g., Adalimumab every 3-4 weeks instead of every 2 weeks). Complete withdrawal carries risk of relapse in most patients, and re-treatment may be required. Re-treatment after biologic withdrawal generally achieves similar efficacy but anti-drug antibodies may develop during the drug-free interval, potentially reducing efficacy. Close monitoring during de-escalation is essential with a clear plan for treatment resumption if relapse occurs.

Reference: BAD 2020 Biologic Psoriasis Guidelines; BJD 2019 Biologic Tapering