Long-term optimization of outcomes with flexible adalimumab dosing in patients with moderate to severe plaque psoriasis. J Eur Acad Dermatol Venereol 2018 Aug;32(8):1297-1304
Date
03/11/2018Pubmed ID
29524255DOI
10.1111/jdv.14926Scopus ID
2-s2.0-85050316751 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: The recently updated dosing recommendation for adalimumab for moderate to severe plaque psoriasis states that patients with inadequate response to adalimumab every other week (EOW) after 16 weeks may benefit from an increase in dosing frequency to 40 mg every week (EW).
OBJECTIVE: To determine the long-term efficacy of adalimumab in patients with psoriasis with flexibility to escalate and de-escalate between EOW and EW dosing.
METHODS: Data from an open-label study in patients with psoriasis who had received adalimumab in phase 2/3 studies and their extensions were included. Patients initially received 40 mg adalimumab EOW for 24 weeks. From weeks 24-252, patients whose Psoriasis Area and Severity Index response was <50% (PASI 50) could have their dose-escalated to 40 mg EW and were re-evaluated at 6 and 12 weeks and then every 12 weeks thereafter. Patients who had their dose-escalated and achieved a PASI 75 response were de-escalated to EOW and could re-escalate to EW if response fell below PASI 50 again; no further de-escalation was allowed. Changes in PASI scores were reported at the last visit before dose escalation or de-escalation.
RESULTS: By week 24, 64.1% of patients in the overall population (n = 1256) achieved ≥PASI 75 response, 40.3% ≥PASI 90 response and 21.7% PASI 100 response. Patients who had a <PASI 50 during weeks 24-252 (349/1256, 27.8%) had their dose-escalated to EW; 182 (52.1%) remained on EW dosing and 167 (47.9%) achieved a PASI 75 response and were de-escalated to EOW; 83 patients were later re-escalated to EW dosing owing to a <PASI 50 response. Dose escalation was not associated with additional safety concerns.
CONCLUSION: Optimizing therapy by temporarily increasing the dosing of adalimumab to EW in patients with psoriasis and an inadequate response to adalimumab 40 mg EOW permitted the achievement and long-term maintenance of clinical improvement.
Author List
Gniadecki R, Leonardi CL, Gordon KB, Gu Y, Geng Z, Nader A, Teixeira HDAuthor
Kenneth Brian Gordon MD Chair, Professor in the Dermatology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdalimumabAdult
Dermatologic Agents
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Psoriasis
Severity of Illness Index
Time Factors
Treatment Outcome
