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Efficacy of switching between tumor necrosis factor-alfa inhibitors in psoriasis: Results from the Italian Psocare Registry - 16/01/14

Doi : 10.1016/j.jaad.2013.10.019 
Stefano Piaserico, MD, PhD a, , Simone Cazzaniga, PhD Math b, Sergio Chimenti, MD, PhD c, Alberto Giannetti, MD, PhD d, Mara Maccarone, BA e, Mauro Picardo, MD f, Andrea Peserico, MD a, Luigi Naldi, MD b

Psocare Study Group*

  The PSOCARE study centres are listed in the Appendix at www.jaad.org.

a Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy 
b Centro Studi Gruppo Italiano Studi In Epidemiologia (GISED), Papa Giovanni XXIII Hospital, Bergamo, Italy 
c Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy 
d Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy 
e Italian Psoriatic Patient Association (Associazione Difesa Pazienti Psoriasici [ADIPSO]), Rome, Italy 
f Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute Rome, Rome, Italy 

Reprint requests: Stefano Piaserico, MD, PhD, Dermatology Unit, Department of Medicine, University of Padua, Via Cesare Battisti 206, 35128 Padua, Italy.

Abstract

Background

Some studies have shown that switching patients from one tumor necrosis factor (TNF)-alfa inhibitor to another may be beneficial when they have an inadequate response or an adverse event.

Objective

We sought to assess the variables predicting the efficacy of the second TNF-alfa inhibitor in patients discontinuing the first TNF-alfa inhibitor.

Methods

Data from all 5423 consecutive patients starting TNF-alfa inhibitor therapy for psoriasis between September 2005 and September 2010 who were included in the Italian Psocare registry were analyzed.

Results

In 105 patients who switched to a second TNF-alfa inhibitor who had complete follow-up data, 75% improvement in the Psoriasis Area Severity Index score (PASI 75) was reached by 29% after 16 weeks and by 45.6% after 24 weeks. Patients who switched because of secondary loss of efficacy (loss of initial PASI 75 response) or adverse events/intolerance were more likely to reach PASI 75 than those who switched as a result of primary inefficacy (PASI 75 never achieved) (hazard ratio 2.7, 95% confidence interval 1.3-5.5 vs hazard ratio 2.0, 95% confidence interval 1.0-3.9 and 1, respectively).

Limitations

There was a small number of patients with complete follow-up data.

Conclusion

PASI 75 response in patients who switched from one anti–TNF-alfa agent to another was significantly reduced in patients who showed primary inefficacy of the first anti–TNF-alfa.

Le texte complet de cet article est disponible en PDF.

Key words : biologics, efficacy, primary inefficacy, psoriasis, secondary loss of efficacy, switching, tumor necrosis factor-alfa inhibitors

Abbreviations used : PASI, PASI 75, TNF


Plan


 Funding sources: None.
 Disclosure: Dr Piaserico received fees for services on advisory panels and lectures from Abbott, Galderma, Janssen-Cilag, Leo Pharma, MSD, Novartis, and Pfizer. Dr Chimenti served and/or is serving as a consultant for Abbott, Merck, Pfizer, and Janssen-Cilag. Dr Giannetti served as a consultant for Abbott, Merck, and Pfizer. Dr Picardo served as a consultant for Abbott and Pfizer. Dr Peserico served and/or is serving as a consultant or received fees for services on advisory panels and lectures from Abbott, Almirall, Galderma, Janssen-Cilag, Leo Pharma, MSD, Novartis, and Pfizer. Dr Naldi is a member of the Global Steering Committee of the Psolar Registry supported by Centocor and serves as a consultant for Janssen-Cilag. Dr Cazzaniga and Ms Maccarone have no conflicts of interest to declare.


© 2013  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 70 - N° 2

P. 257 - février 2014 Retour au numéro
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