title: Switching to adalimumab for psoriasis patients with a suboptimal response to etanercept, methotrexate, or phototherapy: efficacy and safety results from an open-label study.
abstract: BACKGROUND
  Strategies for transitioning patients with psoriasis from suboptimal therapy have not been delineated.
  
  
  OBJECTIVE
  We sought to determine the efficacy and safety of transitioning to adalimumab for the treatment of psoriasis in patients with suboptimal response to prior therapy with etanercept, methotrexate (MTX), or narrowband (NB)-ultraviolet (UV)B phototherapy.
  
  
  METHODS
  In this 16-week, open-label, phase IIIb trial, patients with chronic plaque psoriasis discontinued suboptimal therapy between 11 and 17 days (etanercept) or between 4 and 10 days (MTX and NB-UVB) before initiating adalimumab (80 mg at week 0, then 40 mg every other week from week 1). The primary end point was the percentage of patients achieving a Physician Global Assessment of "clear" or "minimal" at week 16.
  
  
  RESULTS
  At week 16, Physician Global Assessment of "clear" or "minimal" was achieved by 52% of all enrolled patients (79 of 152) and 49%, 61%, and 48% in the etanercept, MTX, and NB-UVB subgroups, respectively. Four patients (2.6%) experienced at least 125% worsening of Psoriasis Area and Severity Index score relative to screening value at any study visit. The adalimumab safety profile was consistent with results from other psoriasis clinical trials.
  
  
  CONCLUSIONS
  This study is limited by its relatively short 16-week duration, small patient enrollment, and open-label design.
  
  
  CONCLUSIONS
  Patients who had a suboptimal response to etanercept, MTX, or NB-UVB phototherapy experienced a similar, approximately 50% likelihood of achieving a clinically relevant response to adalimumab. Immediate transition to adalimumab from prior suboptimal therapy, with no dosage tapering or overlap, had a low risk of psoriasis flare.
authors.affiliation: New York University School of Medicine, New York, New York 10016, USA. bruce.strober@nyumc.org
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Strober
authors.forename: Yves
authors.initials: Y
authors.lastname: Poulin
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Kerdel
authors.forename: Richard G
authors.initials: RG
authors.lastname: Langley
authors.forename: Yihua
authors.initials: Y
authors.lastname: Gu
authors.forename: Shiraz R
authors.initials: SR
authors.lastname: Gupta
authors.forename: Martin M
authors.initials: MM
authors.lastname: Okun
authors.forename: Kim A
authors.initials: KA
authors.lastname: Papp
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D004351:Drug Resistance; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010789:Phototherapy; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate