On-Treatment vs. Off-Treatment Psoriasis Remission

Once a patient achieves on-treatment remission, experts discuss how the next steps require a nuanced, case-by-case discussion. For a patient with psoriatic arthritis and nail involvement, experts strongly favor maintaining ongoing systemic therapy to protect against irreversible joint damage.

For a patient with skin-only disease who achieves sustained remission on an advanced biologic, a cautious trial of dose spacing or discontinuation may be considered if the patient strongly desires it. However, the clinicians note the risk of losing response upon retreatment. The decision hinges on patient factors: the presence of arthritis or high-risk features like scalp/nail disease argues against stopping, while a simple phenotype and patient preference may allow a careful trial. The consensus emphasizes that on-treatment remission is a more reliable and often safer goal than pursuing off-treatment remission with current therapies.