Which Antipsoriatic Drug Has the Fastest Onset of Action?—Systematic Review on the Rapidity of the Onset of Action

Abstract

The time necessary for a treatment to become effective is crucial for patients and physicians but has been largely neglected in the reporting and comparison of clinical trials in dermatology. The aim of this systematic review is to determine the time until the onset of action (TOA) of systemic agents approved for moderate-to-severe psoriasis. Primary outcome is the TOA defined as the weighted mean time until 25% of the patients achieved a psoriasis area and severity index (PASI) 75 response. Among the biologics, infliximab has the shortest TOA (3.5 weeks), followed by ustekinumab (high dose 4.6/low dose 5.1 weeks/not weight adapted), adalimumab (4.6 weeks), etanercept (high dose 6.6/low dose 9.5 weeks), and alefacept (high dose 15.4 weeks/low dose: no data). Among the conventional treatments, good data are available for cyclosporine A (CsA; TOA: 6.0 weeks) and limited data are found for methotrexate (MTX; TOA: high dose 3.2/low dose 9.9 weeks). No data are available for fumaric acid esters and retinoids. This systematic review provides clinically relevant information on the onset of action of antipsoriatic agents, although the data currently available allow only a limited assessment. Psoriasis trials should consider including TOA as an additional outcome measure.

CCL20andIL22Messenger RNA Expression After Adalimumab vs Methotrexate Treatment of Psoriasis

“…Similar to the findings of previous studies, 1,2 we demonstrate faster and more complete clinical disease responses among adalimumab-treated than methotrexate-treated patients. We show that methotrexate responders compared with methotrexate nonresponders experience significant down-regulation of mRNAs in the T H 1-, T H 17-, and T H 22-related signaling pathways and normalization of psoriasis transcriptome genes.…”

“…Despite methotrexate’s significantly lower cost, current evidence suggests that biological agents are safe, have a faster onset of clinical response, and demonstrate an overall higher efficacy than methotrexate. 1,2 However, no known studies have evaluated methotrexate’s effects on pathway regulation in psoriasis or compared the changes induced by methotrexate and biological agents at the genomic, immunohistochemical, and mRNA levels.…”

“…Studies have demonstrated the superior clinical efficacy and faster onset of the clinical response of adalimumab in the treatment of psoriasis compared with methotrexate. 1,2 However, to our knowledge, no investigations have profiled the features of genomic, immunohistochemical, and messenger RNA (mRNA) expression that determine and differentiate responses of psoriatic disease to methotrexate and adalimumab. The primary objective of our study was to characterize the genomic, immunohistochemical, and mRNA signatures associated with methotrexate and adalimumab in the treatment of plaque-type psoriasis.…”

Efficacy and safety of systemic treatments for moderate‐to‐severe psoriasis: meta‐analysis of randomized controlled trials

“…Infliximab is the most efficacious treatment option for induction treatment of psoriasis, and has also been shown to have the fastest onset of action of all of the treatments available. 63 The evidence base indicating efficacy of the biologics infliximab, adalimumab, ustekinumab and etanercept is much stronger than the evidence for efficacy of conventional treatment options for moderate-to-severe psoriasis. Trials investigating biologics for psoriasis were much larger, on average had a longer duration, and had lower risk of bias.…”

Differential management of mild-to-severe psoriasis with biologic drugs: An Italian Delphi consensus expert panel

“…Although the currently available data allow only a limited assessment, a recent systematic review showed that monoclonal antibodies (infliximab, ustekinumab and adalimumab, in decreasing order) have the fastest onset of action (52). Data also showed a significant mean PASI improvement by week 12 in patients receiving etanercept 50 mg twice-weekly dose (53).…”