Efficacy and Safety of Etanercept in Psoriasis after Switching from Other Treatments

Abstract

Since targeted biologic treatments have been introduced for the treatment of plaque-type psoriasis and psoriatic arthritis, switching between different medications has become necessary in selected patients, particularly after treatment failures. To evaluate the efficacy and safety of etanercept treatment in adult patients with psoriasis after failure to respond to other previous therapies. In particular, the differences in efficacy profiles after switching from traditional (cyclosporine [ciclosporin], methotrexate, retinoids, fumaric acid esters, psoralen plus UVA therapy, corticosteroids) or biologic (infliximab, efalizumab) treatments were analyzed. The study included 124 patients affected by plaque-type psoriasis who received etanercept administered subcutaneously at a dosage of 50 mg twice weekly for 12 weeks, followed by 25 mg twice weekly for an additional 12 weeks, and 110 patients affected by psoriatic arthritis who were treated with etanercept 25 mg twice weekly in a continuous regimen, after a 12-week period of treatment with etanercept 50 mg twice weekly. Efficacy results were consistent in both groups of patients (plaque-type psoriasis and psoriatic arthritis), as expressed by the percentage of patients who achieved Psoriasis Area and Severity Index (PASI) 50 and PASI 75 scores. Among psoriatic arthritis patients, the mean pain Visual Analog Scale (VAS) score showed a substantial reduction during the treatment course, from 67.2 at week 0 to 15.8 at week 24. After 24 weeks, among patients with plaque-type psoriasis who had not previously received biologic therapies, 89.9% of patients achieved PASI 50 and 75.3% achieved PASI 75, while among patients who had received biologic therapies, 69.6% of patients achieved PASI 50 and 65.2% achieved PASI 75. In addition, 92.3% of patients with psoriatic arthritis who had not previously received biologic therapies achieved PASI 50 and 73.8% achieved PASI 75, while among patients who had received biologic therapies, 45.8% of patients achieved PASI 50 and 29.2% achieved PASI 75. Our study demonstrated that etanercept was more effective in those patients who had not previously received other biologic therapies than in those who had. The results of the present study indicate that etanercept may represent a valid, effective, and well tolerated therapeutic alternative even after failure to respond to traditional and other biologic therapies.

Effectiveness and Safety of Etanercept in Patients with Psoriatic Arthritis in a Canadian Clinical Practice Setting: The REPArE Trial

“…The clinical benefits of etanercept are well established with regard to peripheral joint disease and skin symptoms 17,20,21,22,23,29 . Thus, in pivotal trials, 12-week treatment with etanercept led to significant increases, relative to placebo, in the proportion of patients with PsA achieving the PsARC and PASI 75-level skin clearance.…”

“…Etanercept discontinuation because of safety concerns has occurred rarely 19,30,37 or not at all 29,36 in available studies, although British patient registry data suggested that about 3% of patients discontinued etanercept per year, citing AE 38 .…”

“…Established clinical benefits of etanercept treatment in PsA include amelioration of skin disease 19,21,22,28,29 , reduction in joint pain and swelling 21 , and prevention of radiographic progression 17,19 . In parallel with these responses, some studies have also established significant benefits in health-related quality of life 17,30,31 .…”

Viewpoint on handling anti-TNF failure in psoriasis

“…Similarly, in patient 8, switching to etanercept after previous TNF-antagonist failure was not successful. Although etanercept may represent an effective and well-tolerated alternative treatment for psoriasis patients who have failed to respond to other therapies (traditional or biologic), it has been reported that etanercept was more effective in biologic naive patients [20]. However, the rate of response to a second TNF antagonist is usually inferior to that of the first [16].…”

The efficacy and safety of infliximab in patients with plaque psoriasis who had an inadequate response to etanercept: Results of a prospective, multicenter, open-label study

“…Data pertaining to patients with psoriasis who switch from one TNF-a antagonist to another, however, have been limited generally to small studies. [14][15][16][17][18][19][20] In the current study, the efficacy of this alternative treatment paradigm was evaluated by assessing clinical response in patients with plaque psoriasis who switch to infliximab after having an inadequate response (IR) to etanercept.…”