title: A prospective randomized controlled trial comparing infliximab and etanercept in patients with moderate-to-severe chronic plaque-type psoriasis: the Psoriasis Infliximab vs. Etanercept Comparison Evaluation (PIECE) study.
abstract: BACKGROUND
  There are currently no independent data available comparing infliximab and etanercept for the treatment of psoriasis.
  
  
  OBJECTIVE
  To compare these biologics without funding from pharmaceutical companies.
  
  
  METHODS
  Overall, 50 patients were randomized to etanercept (n = 23) 50 mg subcutaneously twice weekly or infliximab (n = 25) 5 mg kg-1intravenously at week 0, 2, 6, 14 and 22. After 24 weeks, 19 patients stopped and 22 continued treatment and were followed up to week 48. The primary outcome was ≥ 75% improvement of Psoriasis Area and Severity Index (PASI 75) at week 24. The secondary outcomes included PASI 75 at week 6 (onset of action) and week 12, Investigator's Global Assessment (IGA), Patient Global Assessment, impact on quality of life (Skindex-17 and SF-36), Treatment Satisfaction Questionnaire of Medication, duration of remission, maintenance treatment and safety.
  
  
  RESULTS
  At week 24, PASI 75 was achieved in 72% (infliximab) vs. 35% (etanercept) (P = 0·01). The onset of action was achieved in 52% (infliximab) and 4% (etanercept). At week 12, 76% (infliximab) and 22% (etanercept) achieved PASI 75 (P < 0·001). At week 24, IGA 'clear or almost clear' was observed in 76% (infliximab) and 30% (etanercept) (P = 0·01). Skindex-17 symptom score was significantly better for infliximab. Maintenance treatment achieved PASI 75 for 67% (n = 6) infliximab vs. 50% (n = 5) etanercept, at week 48 (P = 0·65). Mild adverse events were reported in 76% (infliximab) vs. 66% (etanercept).
  
  
  CONCLUSIONS
  Infliximab showed a rapid and significant higher level of efficacy until week 24 compared with etanercept. Long-term data showed no significant differences between both groups at week 48. Safety parameters were comparable.
authors.affiliation: Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
authors.forename: A C Q
authors.initials: AC
authors.lastname: de Vries
authors.affiliation: Department of Dermatology, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands.
authors.forename: H B
authors.initials: HB
authors.lastname: Thio
authors.affiliation: Department of Dermatology, Amphia Hospital, Molengracht 21, 4818 CK, Breda, the Netherlands.
authors.forename: W J A
authors.initials: WJ
authors.lastname: de Kort
authors.affiliation: Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van der Stok
authors.affiliation: Department of Dermatology, UMC St Radboud, René Descartesdreef 1, 6525 GL, Nijmegen, the Netherlands.
authors.forename: E M G J
authors.initials: EM
authors.lastname: de Jong
authors.affiliation: Department of Dermatology, UMC Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Horvath
authors.affiliation: Medical Psychology and Psychotherapy Section, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands.
authors.forename: J J V
authors.initials: JJ
authors.lastname: Busschbach
authors.affiliation: Department of Dermatology, Erasmus Medical Center, 3015 CA, Rotterdam, the Netherlands.
authors.forename: T E C
authors.initials: TE
authors.lastname: Nijsten
authors.affiliation: Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
authors.forename: Ph I
authors.initials: PI
authors.lastname: Spuls
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D000068800:Etanercept / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage* / Q000009:adverse effects; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D000069285:Infliximab; D000068800:Etanercept