title: Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: results from the Italian Psocare registry.
abstract: BACKGROUND
  Some studies have shown that switching patients from one tumor necrosis factor (TNF)-alfa inhibitor to another may be beneficial when they have an inadequate response or an adverse event.
  
  
  OBJECTIVE
  We sought to assess the variables predicting the efficacy of the second TNF-alfa inhibitor in patients discontinuing the first TNF-alfa inhibitor.
  
  
  METHODS
  Data from all 5423 consecutive patients starting TNF-alfa inhibitor therapy for psoriasis between September 2005 and September 2010 who were included in the Italian Psocare registry were analyzed.
  
  
  RESULTS
  In 105 patients who switched to a second TNF-alfa inhibitor who had complete follow-up data, 75% improvement in the Psoriasis Area Severity Index score (PASI 75) was reached by 29% after 16 weeks and by 45.6% after 24 weeks. Patients who switched because of secondary loss of efficacy (loss of initial PASI 75 response) or adverse events/intolerance were more likely to reach PASI 75 than those who switched as a result of primary inefficacy (PASI 75 never achieved) (hazard ratio 2.7, 95% confidence interval 1.3-5.5 vs hazard ratio 2.0, 95% confidence interval 1.0-3.9 and 1, respectively).
  
  
  CONCLUSIONS
  There was a small number of patients with complete follow-up data.
  
  
  CONCLUSIONS
  PASI 75 response in patients who switched from one anti-TNF-alfa agent to another was significantly reduced in patients who showed primary inefficacy of the first anti-TNF-alfa.
authors.affiliation: Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy. Electronic address: stefano.piaserico@unipd.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Piaserico
authors.affiliation: Centro Studi Gruppo Italiano Studi In Epidemiologia (GISED), Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cazzaniga
authors.affiliation: Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Chimenti
authors.affiliation: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Giannetti
authors.affiliation: Italian Psoriatic Patient Association (Associazione Difesa Pazienti Psoriasici [ADIPSO]), Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Maccarone
authors.affiliation: Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute Rome, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Picardo
authors.affiliation: Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peserico
authors.affiliation: Centro Studi Gruppo Italiano Studi In Epidemiologia (GISED), Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Naldi
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000704:Analysis of Variance; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D000069285:Infliximab; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: 75% improvement in the Psoriasis Area Severity Index score; PASI; PASI 75; Psoriasis Area Severity Index; TNF; biologics; efficacy; primary inefficacy; psoriasis; secondary loss of efficacy; switching; tumor necrosis factor; tumor necrosis factor-alfa inhibitors