Efficacy and safety of adalimumab in patients with plaque psoriasis who have shown an unsatisfactory response to etanercept

• Published in: Journal of the American Academy of Dermatology 2010-08, Vol.63 (2), p.228-234
• Main Authors: Bissonnette, Robert, MD, FRCPC, Bolduc, Chantal, MD, FRCPC, Poulin, Yves, MD, FRCPC, Guenther, Lyn, MD, FRCPC, Lynde, Charles W., MD, FRCPC, Maari, Catherine, MD, FRCPC
• Format: Article
• Language: English
• Subjects: Adalimumab; Adult; Aged; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal, Humanized; anti–tumor necrosis factor-alfa; Biological and medical sciences; Body Surface Area; Dermatology; Drug Resistance; Etanercept; Female; Humans; Immunoglobulin G - therapeutic use; Male; Medical sciences; Middle Aged; psoriasis; Psoriasis - drug therapy; Psoriasis - pathology; Psoriasis. Parapsoriasis. Lichen; Receptors, Tumor Necrosis Factor - therapeutic use; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2009.08.040

Background The safety and efficacy of adalimumab in patients who have shown an unsatisfactory response to etanercept are unknown. Objective We sought to evaluate the safety and efficacy of adalimumab in patients who failed to show a satisfactory response or lost their satisfactory response to etanercept. Methods This multicenter study enrolled patients who either failed to reach a physician global assessment (PGA) score of 0 or 1 after 12 weeks of etanercept (group A; 50 patients) or who lost their PGA score of 0 or 1 at any time after etanercept dose decrease from 50 mg twice a week to 50 mg every week (group B; 35 patients). Patients received adalimumab 40 mg every other week without loading dose for 12 weeks followed by 40 mg every week for an additional 12 weeks if they did not reach a PGA score of 0 or 1. Results After 12 weeks of adalimumab, 34.0% (n = 17; 95% confidence interval [CI ] 20.4-47.6) and 31.4% (n = 11; 95% CI 15.2-47.6) of patients from groups A and B, respectively, reached a PGA score of 0 or 1. A total of 46.0% (n = 23; 95% CI 31.7-60.3) and 45.7% (n = 16; 95% CI 28.4-63.1) of patients from group A and B, respectively, achieved a PGA score of 0 or 1 after 24 weeks of adalimumab. Adalimumab was well tolerated and no serious adverse events were reported. Limitations This was an open-label uncontrolled study. Conclusions Adalimumab should be considered as an alternative in patients with psoriasis who have not shown an adequate response or who lost their response to etanercept after a dose decrease.