OBJECTIVES: To describe the results of a program of rational use of biological drugs in an integrated clinic of immune-mediated skin diseases (CLIPSO).

METHODS: Descriptive, cross-sectional study, conducted in July 2022- May 2023, in a cohort of patients diagnosed with immune-mediated dermatologic diseases. Patients were evaluated by a team of physicians, dermatology specialists, and pharmacists, who performed a clinical and pharmacological follow-up of patients and according to their evolution established optimization strategies or avoidability of initiation of biological therapies. A univariate analysis was performed, with summary measures of central tendency, and relative and cumulative frequencies. The statistical package R Core Team Version 4.2 (2022) was used.

RESULTS: During the period evaluated, 1210 patients were identified in treatment with biologic therapy of which 174 patients (14.4%) had their therapy optimized according to their clinical evolution. These patients had a mean age of 46 years (SD: 16), 57% were female and mainly with diagnoses of psoriasis 60.3%, urticaria 19.0%, atopic dermatitis 14.4% and hidradenitis suppurativa 5.7%. Therapy optimization strategies were 45.4% spacing of biologic administration frequency (dupilumab 20.3%, ixekizumab 19%, ustekinumab 16.5%, and adalimumab 11.4%), 24.7% discontinuation of biologic therapy (omalizumab 44.2%, adalimumab 18.6%, and ixekizumab 11.6%), 16.7% avoidability of biologic therapy initiation (adalimumab 24.1%, dupilumab 20.7%, guselkumab 17.2% and apremilast 10.3%); 6.3% chance of treatment (ustekinumab to guselkumab 90%); 5.7% dose reduction (secukinumab 50%, omalizumab 40% and ixekizumab 10%) and 1.1% switch to a biosimilar drug (adalimumab). All patients maintained satisfactory clinical results and a total saving of 419560 USD (2605 USD per patient/month) was generated.

CONCLUSIONS: A biological therapy rationalization program based on an adequate approach and follow-up of patients with immune-mediated skin diseases allows for obtaining satisfactory clinical results and a significant economic impact on the health system.