A new analysis of real-world data from the Belgian Psoriasis Registry suggests that younger patients with psoriasis may achieve better outcomes when treated early with biological therapies, challenging traditional treatment paradigms.
The study, conducted at Erasmus Hospital in Brussels, analyzed data from 205 psoriasis patients, with a median age of 53 years. The research combined both retrospective (104 patients) and prospective (101 patients) analyses, with follow-up periods ranging from less than 35 weeks to over 40 weeks.
Treatment Response Patterns
The investigation revealed that approximately 47% of patients achieved a PASI75 response (75% improvement in Psoriasis Area Severity Index). Among the treatment modalities, biological therapy demonstrated particularly strong results:
- 50% of patients on biologics showed response in short-term follow-up
- 57% response rate for biologics in long-term follow-up
- Conventional systemic therapy reached 55.5% response rate in long-term follow-up
- Topicals/phototherapy achieved 50% response rate
Age-Related Treatment Effectiveness
A striking finding emerged regarding age-related treatment responses. Younger patients demonstrated significantly faster treatment responses compared to their older counterparts. The median age for short-term responders was 36.9 years, while non-responders had a median age of 56.4 years.
The Case for "Step-Down" Approach
Currently, Belgian treatment protocols follow a "step-up" strategy, requiring patients to try phototherapy and conventional systemic therapy before qualifying for biologics. Patients must demonstrate a PASI score over 10 or body surface area (BSA) greater than 10% to become eligible for biological therapy.
However, researchers argue this approach may be suboptimal, citing increased healthcare visits and frequent medication changes as factors that reduce cost-effectiveness. The proposed "step-down" strategy involves:
- Initial treatment with biological therapy
- Dose reduction once remission is achieved
- Implementation of supplemental follow-up forms for data collection
Clinical Implications
The findings align with previous randomized controlled trials, including STEPIn and GUIDE, which demonstrated improved outcomes with early biological therapy initiation. While topical treatments may be initially effective and less expensive for mild cases, researchers note that treatment discontinuation due to efficacy issues and quality of life impact may ultimately equalize the cost difference between treatment modalities.
Future Considerations
While additional research is needed to definitively establish the cost-effectiveness of the "step-down" approach in Belgium, the study suggests this strategy could significantly improve care outcomes, particularly for patients under 45 years of age. The approach promises to enhance disease management while potentially offering greater financial flexibility and improved quality of life for patients.
