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J Am Acad Dermatol. 2016 Sep;75(3):612-618.e6. doi: 10.1016/j.jaad.2016.02.1221. Epub 2016 Apr 6.

Systematic review of efficacy of anti-tumor necrosis factor (TNF) therapy in patients with psoriasis previously treated with a different anti-TNF agent.

Author information

1
Dermatology Institute and Skin Care Center, Santa Monica, California; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California. Electronic address: paulyamauchi@yahoo.com.
2
Innovaderm Research, Montreal, Quebec, Canada.
3
AbbVie Inc, North Chicago, Illinois.

Abstract

BACKGROUND:

Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure).

OBJECTIVE:

We sought to systematically investigate the efficacy and safety of a second TNF antagonist after failure of a first TNF antagonist.

METHODS:

Published primary studies evaluating the efficacy of switching TNF antagonists after failure were systematically extracted.

RESULTS:

Fifteen studies were included. Although response rates to a second TNF antagonist were lower than for a first, a substantial proportion of patients in every study achieved treatment success. Week-24 response rates for a second antagonist were 30% to 74% for a 75% improvement in Psoriasis Area and Severity Index score and 20% to 70% for achieving a Physician Global Assessment score of 0/1; mean improvements in Dermatology Life Quality Index ranged from -3.5 to -13. In general, patients who experienced secondary failure achieved better responses than patients with primary failure. Adverse event incidences ranged from 20% to 71%, without unexpected adverse events; 0% to 11% of patients experienced serious adverse events.

LIMITATIONS:

There was no common definition of treatment failure across these studies of varied design.

CONCLUSIONS:

Some patients benefit from switching to a second TNF antagonist after failure of a first TNF antagonist, with improved quality of life.

KEYWORDS:

adalimumab; etanercept; failure; infliximab; psoriasis; switching; tumor necrosis factor antagonist

PMID:
27061047
DOI:
10.1016/j.jaad.2016.02.1221
[Indexed for MEDLINE]
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