Biologic dose reduction versus standard dosing in psoriasis: what is lost and what is gained?

As increasing numbers of patients with psoriasis achieve stable disease control, biologic dose reduction has become an important question in maintenance treatment. This narrative review synthesizes evidence from randomized controlled trials and observational studies to compare the losses and gains of biologic dose reduction versus continued standard dosing in terms of disease control, safety, quality of life, and healthcare costs. Current evidence suggests that dose reduction may reduce the rates of high-level skin clearance, such as Psoriasis Area and Severity Index (PASI) 90 and PASI 100, and increase transient flares and disease fluctuations during maintenance treatment. By contrast, broader PASI-based response criteria may still be met by many patients after dose reduction, but this does not mean that the response achieved under standard dosing was fully preserved. The clearest gains were lower biologic use and short-term treatment costs, while improvements in quality of life or safety have not been demonstrated. Biologic dose reduction should therefore be considered a cautious, individualized strategy, with decisions informed by the magnitude of any efficacy loss, treatment burden, and patient preferences. This may help move long-term psoriasis management toward more precise and personalized treatment.