Less Is More: Cost-Effective Psoriasis Management via Disease-Driven Dosing of IL-17/IL-23 Inhibitors

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 (2023–2025). Patients with stable disease (PASI ≤3, DLQI ≤3 for ≥9 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 €7,303.57 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.