title: Changes in C-reactive protein in patients with moderate-to-severe psoriasis switched to adalimumab therapy after suboptimal response to etanercept, methotrexate or phototherapy.
abstract: BACKGROUND
  Psoriasis treatment can lower levels of the inflammatory biomarker C-reactive protein (CRP).
  
  
  OBJECTIVE
  Evaluate CRP changes in patients with chronic plaque psoriasis who switched to adalimumab following suboptimal response to previous therapies.
  
  
  METHODS
  C-reactive protein was measured at screening and after 16 weeks of adalimumab treatment following discontinuation of previous therapies: etanercept (substudy E; n = 77), methotrexate (substudy M; n = 38) or narrow-band ultraviolet B phototherapy (substudy P; n = 27). Associations of CRP with baseline characteristics and efficacy measures were evaluated.
  
  
  RESULTS
  Median CRP change at the final visit was -0.3 mg/L overall and -0.4, -0.3 and -0.3 mg/L in substudies E, M and P respectively. Clinical response [Physician Global Assessment (PGA) 'clear' or 'minimal'] was associated with greater CRP reductions vs. no response (PGA 'mild' or worse) overall (-0.4 vs. -0.3 mg/L) and in substudies E (-0.4 vs. -0.1 mg/L) and M (-0.5 vs. -0.2 mg/L), but not P (-0.1 vs. -0.4 mg/L). CRP decreases were, respectively, -0.4 and -0.3 mg/L in patients with and without a history of psoriatic arthritis and -0.1, -0.3 and -0.6 mg/L in normal weight, overweight and obese patients, respectively. CRP decreases after 16 weeks correlated positively (β = 0.004) with percentage change in Psoriasis Area and Severity Index (PASI; P = 0.0398) and negatively (β = -0.360) with baseline CRP (P < 0.0001).
  
  
  CONCLUSIONS
  C-reactive protein levels decreased during adalimumab therapy in patients with psoriasis who experienced suboptimal response to previous therapies. Clinical response was associated with greater CRP reductions overall and in substudies E and M, but not P. CRP reductions correlated with percentage reductions in PASI.
authors.affiliation: Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA; Probity Medical Research Inc, Waterloo, ON, Canada.
authors.forename: B E
authors.initials: BE
authors.lastname: Strober
authors.forename: Y
authors.initials: Y
authors.lastname: Poulin
authors.forename: C
authors.initials: C
authors.lastname: Teller
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: D A
authors.initials: DA
authors.lastname: Williams
authors.forename: O M
authors.initials: OM
authors.lastname: Goldblum
mesh_terms: D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism*; 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 / Q000097:blood* / Q000188:drug therapy / Q000628:therapy; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D002097:C-Reactive Protein; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate