title: Adalimumab for treatment of moderate to severe chronic plaque psoriasis of the hands and feet: efficacy and safety results from REACH, a randomized, placebo-controlled, double-blind trial.
abstract: OBJECTIVE
  To determine the efficacy, safety, and sustainability of response to adalimumab therapy for moderate to severe chronic plaque psoriasis involving hands and/or feet.
  
  
  METHODS
  Sixteen-week, randomized, double-blind, placebo-controlled evaluation of adalimumab therapy for moderate to severe chronic plaque psoriasis involving the hands and/or feet with a 12-week open-label extension (Randomized Controlled Evaluation of Adalimumab in Treatment of Chronic Plaque Psoriasis of the Hands and Feet [REACH]).
  
  
  METHODS
  Multicenter outpatient study in the United States and Canada.
  
  
  METHODS
  Patients with chronic plaque psoriasis on the hands and/or feet with a Physician's Global Assessment of hands and/or feet (hfPGA) score of "moderate" or above.
  
  
  METHODS
  Patients were randomized 2:1 to adalimumab (80 mg at week 0, then 40 mg every other week starting at week 1) or to matching placebo.
  
  
  METHODS
  Percentage of patients achieving an hfPGA score of "clear" or "almost clear" at week 16.
  
  
  RESULTS
  Seventy-two patients (adalimumab [n = 49];placebo [n = 23]) were evaluated. Baseline percentages of patients with moderate and severe hfPGA scores were 76% and 24%, respectively, for the adalimumab group and 74% and 26%, respectively, for the placebo group. At week 16, 31% and 4% of patients randomized to adalimumab and placebo, respectively, achieved an hfPGA score of clear or almost clear (P = .01). At week 28, 80% of the hfPGA clear or almost clear response was maintained from week 16 (25% for patients randomized to adalimumab). Adverse events in both groups were generally mild to moderate. In both periods combined, nasopharyngitis (27% and 13% for adalimumab- and placebo-treated patients, respectively) was most frequently reported.
  
  
  CONCLUSIONS
  Adalimumab is efficacious and well tolerated for treatment of chronic plaque psoriasis of hands and/or feet, with efficacy largely maintained to 28 weeks. Trial Registration clinicaltrials.gov Identifier: NCT00735787.
authors.affiliation: Central Dermatology, 1034 S Brentwood Blvd, Ste 600, St Louis, MO 63117, USA. leonardi@centralderm.com
authors.forename: Craig
authors.initials: C
authors.lastname: Leonardi
authors.forename: Richard G
authors.initials: RG
authors.lastname: Langley
authors.forename: Kim
authors.initials: K
authors.lastname: Papp
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Tyring
authors.forename: Norman
authors.initials: N
authors.lastname: Wasel
authors.forename: Ronald
authors.initials: R
authors.lastname: Vender
authors.forename: Kristina
authors.initials: K
authors.lastname: Unnebrink
authors.forename: Shiraz R
authors.initials: SR
authors.lastname: Gupta
authors.forename: Wendell C
authors.initials: WC
authors.lastname: Valdecantos
authors.forename: Jerry
authors.initials: J
authors.lastname: Bagel
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D002170:Canada; D004311:Double-Blind Method; D005528:Foot; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009304:Nasopharyngitis / Q000139:chemically induced; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab