Adalimumab May Be Effective for Psoriasis Patients Nonresponsive to Etanercept
Presented at AAD
Source: DGNews
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By John Schieszer
SAN DIEGO -- March 21, 2012 -- Switching to adalimumab may lead to clinical response in most patients who had been suboptimally controlled on etanercept, methotrexate, or narrow-band ultraviolet B phototherapy, according to a study results presented at the 70th Annual Meeting of the American Academy of Dermatology (AAD).
“Approximately 40% to 50% of patients receiving standard dosing of etanercept for more than 3 months may be characterised as nonresponders to the drug,” stated study investigator Bruce Strober, MD, PhD, University of Connecticut School of Medicine, Farmington, Connecticut, speaking here on March 19. “The failure of one TNF [tumour necrosis factor]-inhibitor does not preclude the successful use of another member of this class of biologics. Most patients appropriate for treatment with a TNF-inhibitor should try and fail at least 2 members of this class of biologics before being considered for another type of biologic medication approved for psoriasis.”
Dr. Strober and colleagues enrolled 152 psoriasis patients who were adalimumab-naïve and who had suboptimal response to etanercept (n = 82), methotrexate (n = 41) or narrow-band ultraviolet B phototherapy (n = 29). Adalimumab was dosed 40 mg every other week from weeks 1 to 15, following an initial dose of 80 mg at week 0.
The researchers analysed the proportion of patients achieving clinical response (defined as a Physician’s Global Assessment of “clear” or “minimal” at week 16) in the intent-to-treat population with nonresponder imputation for missing data.
The researchers also analysed the results for 2 subgroups: primary nonresponders (never achieved satisfactory response to the prior therapy) and secondary nonresponders (achieved satisfactory response initially but lost it over time). Patients who reported both were included in both subgroups; however, patients who discontinued prior therapies for reasons other than efficacy were not included in the subgroup analyses.
The percentages of primary nonresponders/secondary nonresponders by prior treatment were etanercept 31.7%/70.7%, methotrexate 65.9%/29.3%, and ultraviolet B phototherapy 62.1%/37.9%.
The overall response rate to adalimumab at week 16 was 52.0%. In addition, 60.6% of primary nonresponders and 44.4% of secondary nonresponders achieved clinical response.
Among patients with prior etanercept treatment, clinical response was achieved by 57.7% and 46.6% among those patients in the primary nonresponders group and 46.6% among the patients in the secondary nonresponders group.
Among patients with prior methotrexate therapy, the researchers found that the clinical response was achieved by 63.0% of the primary nonresponders and 50.0% among the secondary nonresponders.
Among patients with prior ultraviolet B phototherapy therapy, clinical response was achieved by 61.1% of the primary nonresponders and 27.3% of the secondary nonresponders.
Funding for this study was provided by Abbott Laboratories.
[Presentation title: Adalimumab Is Effective for Psoriasis Patients Who Are Primary Nonresponders to Etanercept: Subanalysis of an Open-Label Clinical Trial. Abstract 4767]