Predictors of Successful Secukinumab Dose Tapering in Moderate-to-Severe Psoriasis: A Retrospective Study

Background: Psoriasis (PsO) is a prevalent chronic disease affecting millions, with biologic therapies like secukinumab showing efficacy. With the extensive and prolonged use of secukinumab, identifying strategies for successful dose tapering has emerged as a recent challenge. Objective: This retrospective study aims to identify predictors of successful secukinumab dose tapering in patients with moderate-to-severe plaque psoriasis. Methods: This retrospective study included patients who received secukinumab 300 mg weekly for 5 weeks, then every 4 weeks, achieving and maintaining Psoriasis Area and Severity Index (PASI) 90 for ≥ 6 months. Statistical analyses included the Mann–Whitney U -test, Friedman M test, and logistic regression ( P < 0.05). Results: Among the 75 secukinumab-treated patients, 40 (53.33%) successfully tapered their dosage. BMI, dose tapering timing, and pre-tapering treatment duration were significant predictors of tapering success. Seasonal effects were observed, with autumn and winter attempts having an increased risk of failure. PASI 75 and PASI 90 rates dropped from week 6 to 12, with no serious adverse events. Conclusion: Lower BMI, dose tapering initiation in spring and summer, and rapid PASI 90 achievements are associated with successful secukinumab dose tapering. These findings suggest that, under appropriate clinical conditions, dose tapering may be a feasible strategy to maintain disease control while potentially reducing treatment-related costs and minimizing the risk of adverse effects. Plain Language Summary: Psoriasis is a chronic condition impacting many people, and biologicals like secukinumab demonstrate therapeutic benefits. As its use grows, developing effective tapering regimens becomes a challenge.Our study found that dose tapering is feasible in people living with psoriasis who are treated with secukinumab. Lower BMI, tapering in spring-summer, and a rapid PASI 90 response predict success.