Managing the dose escalation of biologics in an era of cost containment: the need for a rational strategy.

Although biologic medications have demonstrated great efficacy for the treatment of psoriasis, a subset of patients fails to respond and others lose response later in the course. In treating a patient who has failed to respond to biologic therapy, clinicians must decide between dose escalation, switching biologics, and adding or switching to a non-biologic systemic drug or phototherapy. Although dose escalation is perhaps the simplest strategy and generally well-tolerated, it confers a tremendous cost burden because doubling the dosage is likely to double the wholesale price. We call for the development of rational strategies for the pricing of dose escalation in order to minimize this phenomenon. We also call for increased transparency surrounding negotiated pricing to ensure that all patients have access to the most effective, affordable treatment options available.