Immunobiologics: Intermittent versus Continuous Use in the Treatment of Moderate to Severe Psoriasis

Immunobiologics are used to treat patients with moderate to severe psoriasis and allow for continuous maintenance therapy for longer periods of time without the adverse effects seen with older systemic medications, such as methotrexate or cyclosporine. However, will patients stop responding to the drug if they discontinue and restart therapy? This review will examine four biologic agents currently used in the treatment of psoriasis – etanercept, adalimumab, infliximab, and ustekinumab — to determine whether patients can re-achieve comparable clinical response with intermittent therapy versus continuous therapy. While some data suggest that continuous immunologic therapy may lead to decreased efficacy over time, etanercept, adalimumab, and ustekinumab provide patients with durable response should a patient need to discontinue and reinitiate treatment. These findings may assist clinicians in selecting an appropriate agent should interruption of therapy be necessary.