ArticleDermatology and therapy2026
Perspectives and Real-World Clinical Practice of Portuguese Dermatologists on Biologic Dose Spacing in Psoriasis: Results from a Nationwide Survey.
Article in Dermatology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBiologic therapies have transformed the management of moderate-to-severe psoriasis but are associated with long-term treatment burden and substantial healthcare costs. Dose spacing, defined as extending dosing intervals in patients with controlled disease, has emerged as a potential optimization strategy. However, data on real-world implementation and clinician perspectives remain limited.
methodsWe conducted a national, cross-sectional survey among Portuguese dermatologists experienced in prescribing biologic therapies for psoriasis. An anonymous, web-based questionnaire assessed clinicians' perspectives and real-world practices regarding biologic dose spacing, including eligibility criteria, preferred biologic classes, implementation strategies, outcomes after loss of disease control, and limiting clinical factors.
resultsSeventy-five dermatologists completed the survey (response rate 48.4%). All respondents considered dose spacing feasible. The most frequently cited eligibility criteria were absolute Psoriasis Area and Severity Index (PASI) ≤ 1, body surface area (BSA) ≤ 1%, and a 90% improvement in PASI (PASI 90). Interleukin-23 (IL-23) inhibitors were perceived as the most suitable class for dose spacing (93.3%). In routine practice, dose spacing was applied frequently by 30.7% of respondents and occasionally by 48.0%. Most clinicians (69.3%) required more than 12 months of sustained disease control before initiating dose spacing, predominantly using progressive extension of dosing intervals (96.0%). IL-23 inhibitors were the biologics most frequently dose-spaced in current practice. Following loss of disease control, 86.7% reported successful recapture of response after reintroduction of standard dosing. The main factors limiting dose spacing were a history of difficult-to-control psoriasis (77.3%) and concomitant psoriatic arthritis (72.0%).
conclusionBiologic dose spacing is already integrated into clinical practice in Portugal. Further prospective studies are needed to establish standardized criteria and guide safe implementation.
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