Etanercept for patients with psoriasis who did not respond or who lost their response to adalimumab or infliximab

BACKGROUND: There is a paucity of data on the use of etanercept in patients who have previously failed a different tumour necrosis factor (TNF) alpha antagonist. OBJECTIVES: To study etanercept in patients who did not achieve a satisfactory response to adalimumab or who lost their response to adalimumab or infliximab and to explore the role of anti-adalimumab and anti-infliximab antibodies in etanercept response. METHODS: Patients with psoriasis who did not achieve a satisfactory response to adalimumab or who lost their response to adalimumab or infliximab were included. All patients received etanercept 50 mg twice a week for 12 weeks followed by 50 mg once a week for 12 more weeks. Anti-infliximab and anti-adalimumab antibodies were measured at baseline. The primary objective was to study the efficacy of etanercept using the proportion of patients who achieved a physician global assessment (PGA) of 0 or 1. RESULTS: A total of 81 patients were included. The proportion of patients who achieved a PGA of 0 or 1 after 24 weeks of etanercept was 20.0% (95% CI 4.8-35.2%) for patients who had an unsatisfactory response to adalimumab, 35.1% (95% CI 19.0-51.3%) and 35.7% (95% CI 7.0-64.4%) for patients who lost their response to adalimumab and infliximab respectively. The proportion of patients who achieved a PGA of 0 or 1 at week 24 was numerically higher for patients who had anti-adalimumab or anti-infliximab antibodies (36.5%) as compared to those without (17.2%; P = 0.08). CONCLUSIONS: Etanercept can be effective in patients with psoriasis who failed a previous TNF alpha antagonist.