Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice

Journal of International Medical Research, Sep 2016

Objective To investigate the efficacy and safety outcomes of combination therapy used to optimize etanercept treatment in patients with psoriasis treated in real-life clinical practice.

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Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice

Downloaded from imr.sagepub.com by guest on September Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice Graziella Babino 1 Alessandro Giunta 1 Manuela Ruzzetti 1 Maria Sole Chimenti 0 Sergio Chimenti 1 Maria Esposito 1 0 Rheumatology, Allergology and Clinical Immunology, Department of Systemic Medicine, University of Tor Vergata , Rome , Italy 1 Department of Dermatology, University of Rome Tor Vergata , Rome , Italy Objective: To investigate the efficacy and safety outcomes of combination therapy used to optimize etanercept treatment in patients with psoriasis treated in real-life clinical practice. Methods: Data from patients presenting with psoriasis, treated initially with etanercept monotherapy, were analysed retrospectively. Patients subsequently treated with combination therapy were further analysed. The Psoriasis Area and Severity Index (PASI) score was recorded for all patients receiving comedication; a subjective pain score was recorded in those with psoriatic arthritis receiving comedication after 12, 24 and 48 weeks' treatment and thereafter at 6-month intervals. Results: From the database of 400 patients treated with etanercept, 37 patients (18 male; 19 female; mean age 59.43 years) underwent combination therapy due to lack of efficacy. Patients received mostly short-term (range 4-34 weeks) comedication with corticosteroids, cyclosporine, methotrexate, nonsteroidal anti-inflammatory drugs, acitretin or sulphasalazine. There were significant reductions in the mean PASI score from baseline at all timepoints. There were also significant reductions in the mean pain VAS score from baseline at all timepoints in patients with psoriatic arthritis. The drug survival rate was 59.6% over a mean duration of 323 weeks of etanercept treatment. The safety profile of combination therapy was satisfactory. Conclusions: Short-term comedication in combination with etanercept may optimize treatment options and improve long-term drug survival in patients with psoriasis. - Creative Commons CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permDisoswionnloapdreodvfirdoemdimthr.esaogreipguinba.clowmobrykgiusesatttornibSuetpetedmabsersp28e,c2if0ie1d6 on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Several therapeutic options are available for the treatment of psoriasis; however, traditional systemic therapies are often unable to meet desired treatment goals and their highdose and/or long-term use is associated with organ toxicity.1–3 Over the past two decades, the introduction of biological agents has dramatically improved treatment outcomes, although they are not effective in all individuals with psoriasis.2 According to current guidelines,4 there is no approved indication for any combination of a biological agent with a conventional systemic treatment in psoriasis, although comedication has been shown to be a frequent dermatological practice in up to 30% of patients receiving a tumour necrosis factor-a antagonist.5–8 Combination treatment may provide improved therapeutic results for patients who inadequately respond to a single drug; moreover, combination therapy may reduce safety concerns and cumulative toxicity, as a lower dose of two single agents may offer a better safety and efficacy profile when used in combination.5–8 The present retrospective study aimed to describe experience of a combination treatment strategy used in real-life clinical practice to optimize etanercept efficacy and drug survival in patients with plaque-type psoriasis or psoriatic arthritis. Patients and methods A retrospective analysis was conducted on a clinical database at the Department of Dermatology, University of Rome Tor Vergata, Rome, Italy, of adult patients with plaque-type psoriasis and/or psoriatic arthritis, initially treated with etanercept monotherapy for a minimum of 6 months in the period between January 2004 and December 2008. Those treated with a combination treatment at baseline and/or a history of active infectious disorders (including active tuberculosis), or a history of serious chronic, recurrent, opportunistic infective diseases, demyelinating diseases or recent neoplasms, were excluded from the study. Pregnant or breastfeeding women were also excluded. Patients were originally eligible for etanercept treatment if they presented with moderate-to-severe psoriasis defined by a Psoriasis Area and Severity Index (PASI) score9 10 and an affected body surface area > 10%, were resistant and/or intolerant to at least two traditional systemic treatments and/or had contraindications to such therapies.4 Coexistence of a joint impairment was diagnosed according to the CASPAR (Classification Criteria (...truncated)


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Graziella Babino, Alessandro Giunta, Manuela Ruzzetti, Maria Sole Chimenti, Sergio Chimenti, Maria Esposito. Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice, Journal of International Medical Research, 2016, pp. 100-105, 44/1 suppl, DOI: 10.1177/0300060515593260