Edoardo Cammarata, Chiara Airoldi, Jacopo Colombo, Andrealuna Ucciero, Luca Mastorino, Veronica Arese, Lorenza Burzi, Franco Castelli, Massimo Chiarpenello, Francesca Graziola, Claudia Leporati, Michela Ortoncelli, Paolo Pella, Ginevra Pertusi, Pietro Quaglino, Simone Ribero, Gianluca Rossotto, Alessia Pisterna, Rossana Tiberio, Paolo Dapavo, Paola Savoia
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.