title: The effectiveness and safety of adalimumab in the treatment of non-reimbursed patients with mild-to-moderate psoriasis.
abstract: BACKGROUND
  Few reports exist on the use of biologics for treating patients with mild-to-moderate psoriasis, especially for non-reimbursed patients.
  
  
  OBJECTIVE
  This study aimed to evaluate the safety and effectiveness of adalimumab in non-reimbursed patients with mild-to-moderate psoriasis.
  
  
  METHODS
  Fifty one patients with mild-to-moderate psoriasis treated with adalimumab 40 mg every other week (eow) in a tertiary referral hospital in Taiwan between 2007 and 2010 were retrospectively reviewed. The clinical effectiveness of adalimumab was assessed using Subject's Global assessment (SGA) and Physician's Global Assessment (PGA), and the reasons for discontinuation were evaluated.
  
  
  RESULTS
  After 12 weeks of adalimumab (40 mg subcutaneously eow without a loading dose) treatment, 66% and 74% of patients had SGA and PGA scores of at least marked improvement (greater than 50% improvement compared with baseline psoriasis), respectively, with 60% and 53% of patients achieving SGA and PGA scores of at least marked improvement after 24 weeks. Ten (71%) of 14 previous non-responders to etanercept achieved a SGA or PGA score of at least marked improvement after adalimumab treatment. Adalimumab was generally well tolerated, but four patients (7.8%) discontinued adalimumab due to adverse events. The mean time required for resumption of systemic anti-psoriatic therapy was 6 months (range, 1-12 months). Apart from financial limitations, the most common reasons for discontinuation were primary (23.5%) and secondary (13.7%) lack of efficacy.
  
  
  CONCLUSIONS
  In non-reimbursed mild-to-moderate psoriasis patients, SGA and PGA remained high for adalimumab. Effectiveness and remission duration were key factors affecting patients' willingness to pay for prolonged adalimumab treatment.
authors.affiliation: Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Chiu
authors.forename: T-S
authors.initials: TS
authors.lastname: Wang
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
authors.forename: T-F
authors.initials: TF
authors.lastname: Tsai
mesh_terms: D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D006801:Humans; D019458:Insurance Coverage; D011565:Psoriasis / Q000188:drug therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013624:Taiwan
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab