Long-term safety and efficacy of etanercept in children and adolescents with plaque psoriasis

• Published in: Journal of the American Academy of Dermatology 2016-02, Vol.74 (2), p.280-287.e3
• Main Authors: Paller, Amy S., MD, Siegfried, Elaine C., MD, Pariser, David M., MD, Rice, Kara Creamer, MS, Trivedi, Mona, MD, Iles, Jan, MD, Collier, David H., MD, Kricorian, Greg, MD, Langley, Richard G., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Cellulitis - chemically induced; Child; Child, Preschool; Dermatology; etanercept; Etanercept - adverse effects; Etanercept - therapeutic use; Female; Headache - chemically induced; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; long-term safety; Male; Nasopharyngitis - chemically induced; open-label; pediatric population; plaque psoriasis; Psoriasis - drug therapy; Respiratory Tract Infections - chemically induced; Severity of Illness Index; Time Factors
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.09.056

Background There are no systemic therapies approved in the United States to treat pediatric psoriasis. Objective We sought to evaluate long-term safety and efficacy of etanercept in children and adolescents with moderate to severe plaque psoriasis. Methods This 5-year, open-label extension study enrolled patients aged 4 to 17 years who had participated in a 48-week parent study. End points included occurrence of adverse events (AEs) and serious AEs including infections, and rates of 75% and 90% improvement in Psoriasis Area and Severity Index score and clear/almost clear on static physician global assessment. Results Of 182 patients enrolled, 181 received etanercept and 69 completed 264 weeks. Through week 264, 161 (89.0%) patients reported an AE, most commonly upper respiratory tract infection (37.6%), nasopharyngitis (26.0%), and headache (21.5%). Seven patients reported 8 serious AEs; only 1 (cellulitis) was considered treatment-related. No cases of opportunistic infections or malignancy were reported. Rates of 75% improvement in Psoriasis Area and Severity Index score (∼60%–70%) and 90% improvement in Psoriasis Area and Severity Index score (∼30%–40%) and static physician global assessment status clear/almost clear (∼40%–50%) were maintained through week 264. Limitations The number of patients remaining on study at week 264 was small. Conclusion Etanercept in pediatric patients was generally well tolerated and efficacy was maintained in those who remained in the study for up to 264 weeks.