The commonest reason a patient stays on an ineffective biologic is that no one ever said when the decision would be made. Each review becomes a small extension - give it another month, the skin looked better last week - and a year passes.
Fix the date at the point of prescribing and write it in the notes and on the patient's copy. Record the baseline objectively: a PASI or a body surface area estimate, a DLQI, and a photograph, because memory of how bad the skin was three months ago is unreliable in both directions. Then state the criterion as well as the date - what response at that date would count as enough to continue.
The corollary is to actually stop when the criterion is not met. A partial response at the assessment point, in a patient whose adherence and dosing are confirmed, is a reason to switch class rather than to wait for a late response that mostly does not come. Adding the date to the prescription is the part that makes this happen; without it, the review is a conversation rather than a decision.
- Write the assessment date and the response criterion in the notes when you start the biologic, not at the first review
- Record a baseline PASI or body surface area, a quality-of-life score and photographs before the first dose
- Confirm adherence and dosing interval before calling a drug a failure
- Give the patient their own copy of the date and the criterion
- Switch class rather than extend when the criterion is not met at the agreed point
Why it matters
The decision to stop an ineffective biologic almost never gets made unless it was scheduled in advance.
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