Responses to ustekinumab in the anti-TNF agent-naïve vs. anti-TNF agent-exposed patients with psoriasis vulgaris.
BACKGROUND
Approximately 20-30% of patients with psoriasis treated with anti-tumour necrosis factor α (TNFα) agents will discontinue treatment within 2 years due to loss of efficacy or side-effects. Switching to another anti-TNFα agent produces clinical responses inferior to previously untreated patients. Ustekinumab binds to the p40 subunit of interleukin (IL)-12 and IL-23 and provides a mechanism of action independent of TNFα.


OBJECTIVE
To investigate the efficacy of ustekinumab in a clinical practice setting and to compare treatment responses to ustekinumab in patients previously treated with TNFα inhibitors and anti-TNFα-naïve patients.


METHODS
Patients receiving either ustekinumab (n=71) or the subcutaneous TNFα inhibitors adalimumab or etanercept (n=108) were identified through the registry of psoriasis patients in our Institutions. Efficacy effect outcome was a 75% improvement in the psoriasis area severity index (PASI75). Kaplan-Meier statistics evaluated the adherence to the treatments expressed as drug survival rate.


RESULTS
PASI75 was achieved in 80% of the ustekinumab-treated patients after a median time of 112 days. There was no difference in efficacy in anti-TNFα-naïve patients compared with anti-TNFα unresponsive patients. Patients treated with ustekinumab showed a superior adherence to treatment in comparison with adalimumab and etanercept.


CONCLUSIONS
Patients were non-randomly assigned to treatment, which potentially may lead to biases. Observation time was short (1 year).


CONCLUSIONS
In clinical practice, the short-term efficacy and patient adherence to ustekinumab are excellent and comparable to the data obtained in clinical trials. Lack of response to previous anti-TNF treatment does not impair clinical response to ustekinumab.
Department of Dermatology, Bispebjerg Hospital, and Faculty of Health Science, University of Copenhagen, Denmark.
A
A
Clemmensen
M
M
Spon
L
L
Skov
C
C
Zachariae
R
R
Gniadecki
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011565:Psoriasis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D000069549:Ustekinumab
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069549:Ustekinumab