title: Adalimumab Efficacy in Patients with Psoriasis Who Received or Did Not Respond to Prior Systemic Therapy: A Pooled Post Hoc Analysis of Results from Three Double-Blind, Placebo-Controlled Clinical Trials.
abstract: BACKGROUND
  There are limited data from randomized controlled clinical trials on the outcomes of biologics after discontinuation of a different systemic therapy. To determine the efficacy of adalimumab in patients who previously received systemic therapy (including failed therapy), we performed a pooled post hoc analysis of Psoriasis Area and Severity Index (PASI) response data from three double-blind, placebo-controlled clinical trials in patients with moderate to severe psoriasis.
  
  
  METHODS
  Patients from the M02-528, REVEAL, and CHAMPION studies who were previously exposed to systemic treatment were categorized based on their response. The efficacy of adalimumab compared with placebo was analyzed at the end of the double-blind treatment period for the overall pooled intent-to-treat population (N = 1469) and subgroups that received (n = 780) or did not respond to (n = 229) previous systemic pretreatments.
  
  
  RESULTS
  Rates for an improvement of ≥75% from baseline in the PASI score (PASI75 response) were significantly greater (p < 0.001) at week 16 in patients treated with adalimumab compared with patients who received placebo in the overall (72.1 vs. 8.0%, respectively), previously treated (72.7 vs. 8.5%), and previously failed treatment (70.4 vs. 8.1%) groups. PASI75 response rates were similar in the overall group and in patients who did not respond to methotrexate, cyclosporine, or psoralen plus ultraviolet A therapy. Improvements of ≥90 or ≥100 % from baseline PASI score were also higher with adalimumab vs. placebo in previously treated patients. Adverse events were similar among subgroups.
  
  
  CONCLUSIONS
  Adalimumab was efficacious for the treatment of moderate to severe psoriasis regardless of prior exposure to systemic therapies or failure of those prior therapies. CLINICALTRIALS.
  NCT00645814, NCT00237887, NCT00235820.
authors.affiliation: Probity Medical Research, 139 Union Street East, Waterloo, ON, N2J 1C4, Canada. kapapp@probitymedical.com.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Papp
authors.affiliation: Department of Dermatology, University of Southern California, Los Angeles, CA, USA.
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.affiliation: Dermatologikum Hamburg, Hamburg, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Reich
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: Mahinda
authors.initials: M
authors.lastname: Karunaratne
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: Wendell
authors.initials: W
authors.lastname: Valdecantos
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011701:PUVA Therapy; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068879:Adalimumab; D008727:Methotrexate