title: Baseline anti-dsDNA concentrations and previous treatments predict response to Adalimumab and Etanercept: a retrospective investigation of 146 psoriasis patients.
abstract: BACKGROUND
  Adalimumab and Etanercept are TNF-α antagonists commonly used for treatment of moderate-to-severe psoriasis and psoriatic-arthritis. Reliable instruments to assist the selection of patients for a specific treatment in a real-world scenario are unavailable.
  
  
  OBJECTIVE
  To identify patient characteristics and baseline laboratory parameters predicting response to Adalimumab- and Etanercept-treatment.
  
  
  METHODS
  We report a retrospective observational study including 116 and 64 psoriasis-patients treated with Adalimumab and Etanercept, respectively, at a dermatological outpatient clinic of a university hospital. Thirty four patients contributed data to both biologics. First occurrence of either loss-of-response or serious-side-effects (LOR/SSE) was chosen as clinical endpoint and predictors were identified using Cox-regression.
  
  
  RESULTS
  Baseline anti-double-stranded DNA (anti-dsDNA) concentrations, number of previous treatments with TNF-α antagonists in general and previous treatment with Etanercept in particular significantly predicted LOR/SSE to Adalimumab. The predictive effect of baseline anti-dsDNA was conserved in TNF-α antagonist naïve patients. Number of previous systemic treatments other than TNF-α antagonists significantly predicted LOR/SSE to Etanercept. Age and baseline psoriasis area and severity index (PASI) did not predict response to either biologic in a clinically significant manner.
  
  
  CONCLUSIONS
  Our data suggests that treatment with Adalimumab may promise best results in psoriasis-patients with (A) low baseline anti-dsDNA concentrations, and (B) no previous TNF-α antagonist treatment. A clinically significant predictive effect of age and baseline PASI on response to Adalimumab and Etanercept is unlikely.
authors.affiliation: Department of Dermatology, University of Heidelberg, INF 440, 69120 Heidelberg, Germany. Electronic address: jochen.hoffmann@med.uni-heidelberg.de.
authors.forename: Jochen H O
authors.initials: JH
authors.lastname: Hoffmann
authors.affiliation: Department of Dermatology, University of Heidelberg, INF 440, 69120 Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Knoop
authors.affiliation: Department of Dermatology, University of Heidelberg, INF 440, 69120 Heidelberg, Germany.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Enk
authors.affiliation: Department of Dermatology, University of Heidelberg, INF 440, 69120 Heidelberg, Germany.
authors.forename: Eva N
authors.initials: EN
authors.lastname: Hadaschik
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000276:immunology* / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000974:Antibodies, Antinuclear; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept
keywords: Autoantibodies; Biomarkers; Psoriasis; TNF-α antagonist