Abstract
Biologic dosing frequency is a key concern among psoriasis (PsO) patients and physicians, yet dosing optimization remains a challenge. This study evaluates patient dosing preferences for IL-17 and IL-23 inhibitors, risankizumab (RZB) every 12 weeks, guselkumab (GUS) every 8 weeks, and ixekizumab (IXE) every 4 weeks, in managing PsO. This phone survey study evaluated 87 adults on RZB (n = 29), GUS (n = 35), or IXE (n = 23) from 2019 onward at two clinical sites. Patients were assessed for baseline PsO bothersome severity, current dosing frequency satisfaction, frequency of PsO flares, and preferred dosing frequency. Most patients were males (57.5%) with an average age of 54.1 years and an average treatment duration of 19.0 months. At baseline before treatment, 87% were ‘very bothered’ by their PsO. After treatment, 86% were either ‘3-somewhat’ or ‘4-very satisfied’ with their current dosing schedule, with no significant differences between each drug (P = 0.7). Across all biologics the majority of participants (62% with RZB, 57% with GUS, and 48% with IXE) preferred maintaining their current dosing frequency. No statistically significant differences were observed in dosing frequency preference between treatment groups, suggesting dosing schedule is not a primary concern for most patients. This aligns with previous research demonstrating effective disease control is the most important factor for patient satisfaction; however, tailoring dosing regimens to individual patient needs can also strengthen long-term adherence, as demonstrated in recent studies.
Keywords: psoriasis, dosing, risankizumab, guselkumab, ixekizumab, survey
Report
More than 50% of physicians consider dosing frequency among the top three most crucial factors when prescribing biologics. 1 This poses a challenge given the lack of literature regarding dosing optimization and patient dosing preference. Common biologics used to manage psoriasis include IL-17 and IL-23 inhibitors administered every 12 weeks (risankizumab; RZB), 8 weeks (guselkumab; GUS), or 4 weeks (ixekizumab; IXE). This survey study characterizes patient preference for dosing frequency in the treatment of psoriasis.
Ninety-four adult patients prescribed RZB, GUS, or IXE by two dermatologists since 2019 at Pennsylvania Dermatology Partners or Piedmont Plastic Surgery & Dermatology were surveyed via phone in March 2024. The survey included four items: baseline PsO bothersome severity (0-never bothered to 2-very bothered); current dosing frequency satisfaction (0-very unsatisfied to 4-very satisfied); frequency of PsO flares (0-never to 3-all the time); and preferred doing frequency (0-less, 1-no change, 2-more).
Eighty-seven surveys were completed (94.6% response rate), of which 29 were prescribed RZB, 35 were prescribed GUS, 23 were prescribed IXE (Table 1). The majority preferred maintaining their current dosing frequency (RZB 62%, GUS 57%, and IXE 48%) (Table 2). Notably, while the frequency preference between RZB and GUS was comparable, a substantial proportion of IXE patients (39%) expressed a preference for less frequent dosing.
Table 1.
Baseline Characteristics Among Survey Participants.
| Variables | Risankizumab (12-week interval) | Guselkumab (8-week interval) | Ixekizumab (4-week interval) | P-value b |
|---|---|---|---|---|
| N = 29 a | N = 35 a | N = 23 a | ||
| Age | 53 (41, 63) | 56 (44, 62) | 55 (44, 64) | >0.9 |
| Gender | 0.13 | |||
| Female | 12 (41%) | 12 (34%) | 13 (57%) | 0.13 |
| Male | 17 (59%) | 23 (66%) | 10 (43%) | 0.13 |
| Treatment duration (Months) | 21 (12, 28) | 22 (13, 28) | 12 (7, 19) | 0.022* |
aMedian (IQR); Mean (SD); n (%).
bKruskal-Wallis rank sum test; Pearson’s Chi-squared test; Fisher’s exact test – Comparing biologics per respective category. P < 0.05 level of significance.
Table 2.
Questionnaire Responses Among Survey Participants.
| Questionnaire | Risankizumab a | Guselkumab a | Ixekizumab a | P-value b |
|---|---|---|---|---|
| Baseline psoriasis bother (0-2; higher = more bothered) | 1.86 (0.35) | 1.86 (0.43) | 1.87 (0.34) | >0.9 |
| Current frequency satisfaction (0-4; higher = more satisfied) | 3.46 (0.84) | 3.31 (0.99) | 3.41 (1.05) | 0.7 |
| Exacerbations (0-3; higher = more frequent) | 0.71 (0.94) | 0.97 (0.89) | 0.96 (1.02) | 0.4 |
| Frequency preference | 0.7 | |||
| Less | 6 (21%) | 9 (26%) | 9 (39%) | 0.3 |
| Same | 18 (62%) | 20 (57%) | 11 (48%) | 0.5 |
| More | 5 (17%) | 6 (17%) | 3 (13%) | >0.9 |
aMean (SD); n (%).
bPearson’s Chi-squared test; Fisher’s exact test – Comparing biologics per respective category. P < 0.05 level of significance.
Despite varying dosing intervals across the three biologics, there was no significant difference in satisfaction based on dosing regimen. Most respondents in each group preferred to maintain their current dosing schedule, regardless of frequency. All groups reported high baseline bother from their psoriasis, yet after treatment, respondents achieved similar levels of disease control, reflected by similar exacerbation and satisfaction scores. These findings demonstrate treatment efficacy may be a more important driver of patient preference than dosing frequency. However, careful interpretation is warranted due to limitations, namely potential underpowering due to sample size, hindering the detection of significant effects. A larger sample would facilitate a more robust assessment. Furthermore, the restricted survey scale, unaccounted prior biologic use, comorbidities like psoriatic arthritis, and formulation changes to IXE prior to 2022 may have influenced patient responses. Nevertheless, these findings corroborate previous studies in PsO and AD, where most patients rated efficacy highest in treatment selection over dosing frequency.2,3 Furthermore, long-term efficacy demonstrates the greatest predictor of patient adherence to biologic therapy. 4 However, nearly twice as many IXE patients preferred less frequent dosing compared to those on RZB or GUS. Recent real-world evidence supports extending dosing intervals for IL-23 inhibitors like RZB and GUS, for up to 16-24 weeks and 12-16 weeks respectively, among stable patients. 5 This practice reduces injection burden compared to IXE while preserving efficacy, highlighting dosing frequency as a relevant factor for patient convenience and long-term adherence. Moreover, extending dosing intervals for well-controlled patients substantial health care cost savings, often mandated by payors outside the United States. While patients primarily value efficacy, optimizing dosing frequency provides a critical opportunity to further reinforce the long-term adherence essential for effective psoriasis management and sustained clinical benefit, ultimately improving patient satisfaction and disease control.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Statement
Ethical Approval
This study protocol was reviewed by the Institutional Review Board at the University of Rochester Medical Center and determined to be exempt from further review.
Informed Consent
Verbal consent was obtained from all participants prior to conducting the phone survey after explaining the study's purpose and voluntary nature.
ORCID iD
Fahad Ahmed https://orcid.org/0000-0001-5893-7910
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.*
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.*