P141 Maintaining disease control on systemic immunomodulatory therapy for psoriasis: a systematic review and meta-analysis

Abstract

With increasing use of targeted therapies in psoriasis, more patients are achieving disease control. Understanding the durability of control is essential to inform longer-term management. We aimed to estimate, among individuals achieving well-­controlled psoriasis, the proportion who maintain control while continuing systemic immunomodulatory therapy. MEDLINE, Embase, CENTRAL and Web of Science were searched on 1 April 2025 for studies reporting maintenance of control (i.e. improvement to mild psoriasis or better) while continuing systemic immuno­modulatory therapy (PROSPERO CRD420251089461). Studies defining disease control using a disease activity measure at one timepoint and applying nonresponder imputation for missing data were pooled using random effects meta-analysis. The primary outcome was the proportion maintaining clear, nearly clear or mild psoriasis after achieving control. Secondary outcomes were factors associated with sustained control. Study quality was assessed using an adapted Newcastle–Ottawa Scale. Across 65 studies, 2524 individuals achieved clear, 9642 achieved nearly clear and 7771 achieved mild psoriasis. Evidence for conventional systemic and small-molecule therapies was insufficient for pooling. For biologic therapies, 41 studies met the criteria for meta-analysis. Among individuals achieving clear, nearly clear and mild psoriasis, 73% [95% confidence interval (CI) 2–100], 68% (95% CI 47–84) and 70% (95% CI 56–81) maintained the same level of control at ≥ 24 months. Interleukin (IL)-17 and IL-23 inhibitors were associated with better maintenance of nearly clear and mild psoriasis than tumour necrosis factor (TNF) inhibitors. No studies of TNF inhibitors defined disease control as clear, precluding comparisons. Three studies reported factors associated with sustained control, including lower body mass index, shorter disease duration, biologic-naive status and higher serum drug concentrations. This systematic review and meta-analysis indicate that over two-thirds of individuals who achieved psoriasis control maintained it for ≥ 24 months on biologic therapy. Evidence for conventional systemic and small-molecule therapies remains limited. Patient- and drug-specific factors influencing durability of control may help tailor long-term management to optimize outcomes.