Effect of infliximab on health-related quality of life and disease activity by body region in patients with moderate-to-severe psoriasis and inadequate response to etanercept: results from the PSUNRISE trial.

Abstract

BACKGROUND:

Treatment with tumor necrosis factor (TNF)-α antagonists is effective in patients with moderate-to-severe plaque psoriasis, including those with impaired health-related quality of life (HRQoL).

METHODS:

PSUNRISE is a multicenter, open-label, prospective study evaluating the efficacy and safety of switching from etanercept to infliximab in psoriasis patients with an inadequate response to etanercept. Patients received intravenous infusions of infliximab 5 mg/ kg at weeks 0, 2, 6, 14, and 22. HRQoL was assessed using the Dermatology Life Quality Index (DLQI), the 36-item Short-Form Health Survey (SF-36), and the EuroQoL (EQ-5D) index and EQ-5D visual analog scale (VAS; 0-100 cm) among patients receiving at least one infliximab infusion. Subgroup analyses (t- test) were performed to compare mean DLQI improvement between patients who achieved and did not achieve clinical response (Physician's Global Assessment [PGA] 0/1 and at least a 75% improvement in the Psoriasis Area and Severity Index [PASI 75]) at weeks 10 and 26.

RESULTS:

A total of 215 patients received at least one infliximab infusion. A DLQI score of 0 or 1 (no negative effect on HRQoL) was achieved by 3.7%, 44.2%, and 41.4% of patients at weeks 0, 10 and 26, respectively. Mean changes in SF-36 Physical Component Summary scores were 1.8 (week 10) and 2.4 (week 26); corresponding changes in Mental Component Summary scores were 4.5 and 5.0. The mean change in EQ-5D index score was 0.08 at week 10 and 0.09 at week 26; respective mean changes in EQ-5D VAS score were 7.73 and 9.49. Mean improvements in DLQI were significantly higher for patients achieving versus those not achieving PGA 0/1 (P=0.0193 [week 10] and P=0.0010 [week 26]) and PASI 75 response (P<0.0001 [week 10]; P=0.0012 [week 26]).

CONCLUSION:

Psoriasis patients with prior inadequate response to etanercept demonstrated sustained improvements in HRQoL after switching to infliximab, and HRQoL improvements were associated with clinical responses.

• Authors: Robert E Kalb, Andrew Blauvelt, Howard L Sofen, Marc Chevrier, David Amato, Stephen Calabro, Jim Wang, Brad Schenkel, Alice B Gottlieb
• Journal: Journal of drugs in dermatology : JDD (J Drugs Dermatol) Vol. 12 Issue 8 Pg. 874-80 (Aug 2013) ISSN: 1545-9616 [Print] United States
• PMID: 23986160 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Dermatologic Agents
• Immunoglobulin G
• Immunologic Factors
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha
• Infliximab
• Etanercept

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• Dermatologic Agents (therapeutic use)
• Etanercept
• Female
• Humans
• Immunoglobulin G (therapeutic use)
• Immunologic Factors (therapeutic use)
• Infliximab
• Male
• Middle Aged
• Prospective Studies
• Psoriasis (drug therapy, pathology)
• Quality of Life
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)