148 Increasing to weekly adalimumab dosing leads to improved psoriasis outcomes-a retrospective single centre review of real-world data

Adalimumab is a well-tolerated and effective biologic treatment for psoriasis. Given its efficacy and biosimilar availability, it is often a first-line biologic. Clinical trial data have demonstrated that dose escalation from fortnightly to weekly is an effective and safe strategy. However, real-world data is lacking; therefore we aimed to assess patient response to dose escalation in the clinical setting. We reviewed records of patients treated with weekly adalimumab between January 2018-May 2022. Criteria for inclusion were patients prescribed adalimumab fortnightly for three months prior to dose escalation, with PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life Quality Index) scores recorded at dose escalation (baseline) and 3 or 6-months. 45/72 met inclusion criteria. Male to female ratio was 22:23 and mean age 51.6 years. Adalimumab (Amgevita) was the first biologic agent in 84% (38/45). Baseline mean PASI and DLQI were 9.2 (SD 6.3) and 12.1 (SD 7.6), respectively. At 3 months, 62% (10/26) had an improved PASI and DLQI, with 38% achieving PASI 50 and 15% achieving PASI 75 versus baseline. This improvement was sustained at 6 months. 45%(13/29) with data at 6 months achieved PASI 50 and 21% (6/29) PASI 75. 16/45 had switched to an alternative biologic and 3/45 had methotrexate added at the point of data collection. At dose escalation, 70% (23/33) of patients with measured adalimumab levels were subtherapeutic (<5 μg/ml). 12 patients had levels measured at baseline and 3-6 months. 6/12 had an increased level (mean increase 2.6μg/ml, SD 4.4) with a reflected PASI increase in 5/6. 5/33 had adalimumab antibodies at dose escalation. Surprisingly, 2/5 experienced PASI improvement, without an increased adalimumab level. 4/12 had undetectable levels on both occasions, all of which had antibodies. In conclusion, real-world data demonstrates that adalimumab dose escalation is an effective treatment strategy when standard dosing is ineffective, with co-existing potential economic benefit versus switching.