Baseline anti-dsDNA concentrations and previous treatments predict response to Adalimumab and Etanercept: a retrospective investigation of 146 psoriasis patients.

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.
To identify patient characteristics and baseline laboratory parameters predicting response to Adalimumab- and Etanercept-treatment.
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.
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.
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.
AuthorsJochen H O Hoffmann, Christian Knoop, Alexander H Enk, Eva N Hadaschik
JournalJournal of dermatological science (J Dermatol Sci) Vol. 76 Issue 3 Pg. 180-5 (Dec 2014) ISSN: 1873-569X [Electronic] Netherlands
PMID25306295 (Publication Type: Journal Article, Observational Study)
CopyrightCopyright © 2014 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.
Chemical References
  • Antibodies, Antinuclear
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Adalimumab
  • Etanercept
  • Adalimumab
  • Adult
  • Antibodies, Antinuclear (blood)
  • Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
  • Disease-Free Survival
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G (adverse effects, therapeutic use)
  • Immunosuppressive Agents (adverse effects, therapeutic use)
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Psoriasis (immunology, therapy)
  • Receptors, Tumor Necrosis Factor (therapeutic use)
  • Retrospective Studies
  • Tumor Necrosis Factor-alpha (antagonists & inhibitors)

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