Study shows twice weekly etanercept (enbrel) clears psoriasis lesions more quickly than once weekly treatment


Study shows twice weekly etanercept (enbrel) clears psoriasis lesions more quickly than once weekly treatment

Initial treatment with twice weekly etanercept (Enbrel), a tumour necrosis factor antagonist, achieves more rapid clearance of skin lesions than once weekly treatment in patients with active psoriasis and psoriatic arthritis, according to results from the PRESTA study reported recently in the British Medical Journal.

The international study randomised 752 patients with both psoriasis and psoriatic arthritis to etanercept 50mg twice weekly or 50mg once weekly for 12 weeks, given by subcutaneous injection. All patients were then given etanercept 50mg once weekly for an additional 12 weeks.

Results showed that nearly half (46%) of patients treated with etanercept twice weekly achieved 'clear' or 'almost clear' on the physician's global assessment of psoriasis at week 12. This compared with just under one-third (32%) of the patients treated with once weekly etanercept (p (BMJ 2010; 340:c147).

More than three quarters of patients in both treatment regimens achieved improvement in their joint symptoms, evaluated by rheumatologists as reaching psoriatic arthritis response criteria (77% in the twice weekly treatment group and 76% in the once weekly group).

In the EU, the summary of product characteristics recommended different dose regimens of etanercept for psoriasis (either 50 mg weekly or 50 mg twice weekly for 12 weeks followed by 50 mg weekly) and psoriatic arthritis (50 mg weekly). The aim of the PRESTA (Psoriasis Randomized Etanercept STudy in Subjects with Psoriatic Arthritis) trial was to determine the efficacy of two different etanercept regimens not previously studied in patients with both moderate to severe psoriasis and active psoriatic arthritis. It was unique in its collaboration between dermatologists and rheumatologists for evaluating both skin and joint symptoms.

The researchers, led by Wolfram Sterry, chair of the department of dermatology and allergy at the Charité University Medicine, Berlin, Germany, explained the challenge: "Patients with this combination of skin disease and arthritis present a management challenge, as they have two serious disease manifestations. However, similarities in the pathological processes present an opportunity to use a single treatment to effectively treat both components."

Further data from the PRESTA study showed that treatment with etanercept improved patients' quality of life. Before starting therapy, patients with both psoriasis and psoriatic arthritis had poor quality of life: 95% reported pain or discomfort, 71% reported problems with mobility and 68% reported problems conducting usual activities. After 24 weeks of etanercept treatment, the proportion of patients reporting no pain or discomfort had increased by 35%, patients reporting no problem with mobility had increased by 41% and those reporting no problem conducting usual activities had increased by 37% (EADV 2009; abstract P116).

Professor Sterry said: "For patients with plaque psoriasis and psoriatic arthritis, etanercept 50 mg twice weekly was superior to 50 mg once weekly for skin manifestations at week 12 but similar for joint manifestations." He added that both regimens achieved significant improvement from baseline in skin, joint, and entheseal disease components at week 24 without notable differences in safety. "Either etanercept dose regimen can be used in the treatment of psoriasis with or without the presence of psoriatic arthritis, allowing for individualised care," he concluded.

Commenting on the findings, Professor Robert Strohal, Associate Professor of Dermatology at the University Teaching Hospital of Feldkirch, Austria, said: "The fascinating key point is that joints and skin react differently to different etanercept dosages. The skin shows a significant higher response rate with 50mg twice weekly compared to once weekly at week 12. This has important clinical implications. In those psoriasis patients which are 'at high need' it makes sense to start with 50mg twice weekly. Moreover, reducing the dosage at week 12 does not lead to a lowering of the efficacy. Notably, patients are maintaining this better response rate until week 24 and the etanercept 50mg once weekly dosage needs six further weeks to approach the level of the 50mg twice weekly response. So the higher dosage also provides the patient with a gain of time."

Comparative effectiveness of biologic agents for the treatment of psoriasis (Video Medical And Professional 2020).

Section Issues On Medicine: Disease