Pattern of response in patients with moderate-to-severe psoriasis treated with etanercept

• Published in: British journal of dermatology (1951) Vol. 172; no. 1; pp. 230 - 238
• Main Authors: Griffiths, C.E.M., Sterry, W., Brock, F., Dilleen, M., Stefanidis, D., Germain, J.M., Mallbris, L.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.01.2015
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Antirheumatic Agents - administration & dosage; Arthritis, Psoriatic - drug therapy; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Etanercept; Female; Humans; Immunoglobulin G - administration & dosage; Male; Medicin och hälsovetenskap; Middle Aged; Psoriasis - drug therapy; Receptors, Tumor Necrosis Factor - administration & dosage; Treatment Outcome
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.13139

Summary Background Etanercept (ETN) 50 mg once weekly (QW) or 50 mg twice weekly (BIW) for 12 weeks, followed by 50 mg QW in all subjects to Week 24 improved psoriasis in patients with concomitant psoriatic arthritis in the PRESTA trial. Objectives To use data from PRESTA to evaluate the effect of ETN in the treatment of psoriasis by Psoriasis Area Severity Index (PASI) body‐region and component, and determine if PASI responses correlate with the Dermatology Life Quality Index (DLQI). Methods Median time to 75% improvement in PASI (PASI75), body‐ and component‐specific subscales over 24 weeks were estimated. Pearson correlation coefficients determined the association between DLQI score and PASI total score, body‐ and component‐specific subscales with ETN treatment at baseline and up to Week 24. Results In total, 748 patients from PRESTA were included (ETN 50 mg QW/QW, n = 371; BIW/QW, n = 377). Patients achieved PASI75 total score and 75% improvements in all body regions and components faster on ETN 50 mg BIW/QW than QW/QW (all P < 0·05). Median time to 75% improvement was faster for the head and trunk followed by upper and lower extremities, and for induration and desquamation followed by erythema and total area. Weak to moderately positive correlations between improvements in DLQI and PASI total score (r = 0·223–0·463), all PASI body‐specific (r = 0·114–0·432) and component‐specific (r = 0·178–0·478) subscales were observed over 24 weeks. Conclusions Etanercept treatment‐response appears to occur in a body‐ and component‐specific manner. Changes in quality of life are not captured by PASI or its subscales. What's already known about this topic? Etanercept (ETN) is a tumour necrosis factor inhibitor approved for the treatment of moderate‐to‐severe plaque psoriasis. The dosing regimen of ETN 50 mg twice weekly is superior to 50 mg once weekly at achieving a 75% reduction in psoriasis area severity index after 12 weeks' treatment. Patients with psoriasis treated with ETN show improvements in health‐related quality of life. What does this study add? In patients with moderate‐to‐severe psoriasis, 75% improvements are achieved faster with ETN 50 mg twice weekly than 50 mg once weekly for all PASI body regions and components. ETN reduces skin disease signs most quickly on the head and trunk; the fastest responses are observed in the components of desquamation and induration. Recognition of a pattern of treatment response could help to predict future outcomes and manage patient expectations.