Etanercept: An Evolving Role in Psoriasis and Psoriatic Arthritis

Abstract

Tumor necrosis factor alpha (TNFalpha) plays a key pathophysiological role in psoriasis and psoriatic arthritis (PsA). Recent interest has thus focused on the clinical potential of TNFalpha antagonists (e.g. etanercept) in these settings. In psoriasis, several large pooled analyses and well-designed clinical trials documented the significant clinical efficacy and generally favorable tolerability of etanercept for up to 96 weeks. Similarly, in PsA, a large phase III trial showed that, etanercept significantly reduced arthritic symptoms and inhibited radiographic disease progression; sustained clinical benefit was again evident for up to 2 years. Etanercept is at the forefront of psoriatic disease management, and continued evolution and evaluation of the compound - for example, in detailed comparative studies and economic analyses - is likely to confirm a key role for etanercept in the treatment of psoriasis and PsA.

Contrasting pathogenesis of atopic dermatitis and psoriasis—Part II: Immune cell subsets and therapeutic concepts

“…Anti-TNF agents have been successful in treating psoriasis, [162][163][164] probably because TNF and its synergistic interaction with IL-17 mediate pathogenesis. 165 Furthermore, TNF antagonists inhibit the pathogenic T H 1 and T H 17 cell responses that contribute to psoriasis.…”

New era of biologic therapeutics in atopic dermatitis

“…[121117] Furthermore, TNF antagonists inhibit the pathogenic Th1- and Th17-cell responses that contribute to psoriasis. [141,142137, 138] However, a pilot study of the effects of the TNF antagonist, infliximab, in patients with moderate-to-severe AD, and another study on etanercept in two children, demonstrated had disappointing results, [143, 144139] possibly because TNF-induced inflammatory responses have only a minor role in AD. [47,12143, 117] Although clinical improvement was obtained, the patients did not show sustained responses.…”

“…[145,146140,141] Inhibitors of PDE have shown clinical benefit when used topically in AD patients. [148143] An open label study with Apremilast, a novel oral PDE4 inhibitor that is currently in phase 2 clinical trials for psoriasis, was given to 16 adult patients with moderate to severe AD, in two cohorts of 6 patients receiving a lower dose of 20 mg twice daily and 10 on the higher dose of 30 mg twice daily.…”

Efficacy of etanercept for the treatment of psoriasis: an overview of the Italian clinical experience from the real-life setting and independent studies

“…(2) Several evidences support the sustained efficacy and safety of etanercept in psoriasis, as both intermittent and continuous therapy. (3)(4)(5)(6)(7)(8)(9) …”