Etanercept Provides Durable Benefit for Psychiatric Symptoms in Psoriasis Patients: Presented at EADV

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Title: Etanercept Provides Durable Benefit for Psychiatric Symptoms in Psoriasis Patients: Presented at EADV
URL: http://www.pslgroup.com/dg/22CCBA.htm
Doctor's Guide
September 19, 2008

By Jill Stein

PARIS -- September 19, 2008 -- Etanercept produces sustained improvement in depression and anxiety for up to 54 weeks of treatment in patients with active plaque psoriasis, whether treatment is continuous or intermittent, researchers said here at the 17th European Academy of Dermatology and Venereology (EADV) Congress.

Julien Lambert, MD, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium, and associates examined the effect of the fully-human tumour necrosis factor-soluble receptor etanercept on symptoms of depression and anxiety in patients with active plaque psoriasis.

Patients had moderate to severe active plaque psoriasis involving at least 10% of body surface area and a Physician Global Assessment (PGA) status of at least 3. They also had failed to respond to, or had a contraindication to, or were intolerant of methotrexate, cyclosporine, psoralen plus ultraviolet A radiation, or fumaric acid.

"Psoriasis can have a significant psychological impact and can lead to depression and anxiety," Dr. Lambert pointed out. "The prevalence of depression in psoriasis patients ranges from 10% to 58%."

At a tertiary clinic for psoriasis, about 43% of patients satisfied the criteria for anxiety disorder, he added.

For the trial, 711 patients were randomly assigned to 54 weeks of treatment with etanercept, either continuously or intermittently, in a treat-to-response fashion, with temporary interruption of therapy based on a PGA of "mild" or better.

Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale depression (HADS-D) and anxiety (HADS-A) subscales.

At baseline, 30.2% of patients in the continuous-therapy group and 36.7% of the patients in the intermittent-therapy group had symptoms of depression. At the end of the trial, these symptoms were present in 17.5% and 23.1% of patients, respectively.

Mean improvements in HADS-D scores for the 2 groups from baseline were 30.4% and 25.1%, respectively (P < .001 within group; P = NS between groups).

At baseline, 40.2% of the continuous-treatment group and 48.5% of the intermittent-therapy group had anxiety symptoms. At week 54, these symptoms were present in 25.1% and 31.8% of patients, respectively. Mean improvement in HADS-A scores from baseline were 27.3% and 24.4%, respectively (P < .001 within group; P = NS between groups).

Overall, the results showed that with either a continuous or an intermittent etanercept regimen, improvement in the prevalence of depression and anxiety symptoms was seen as early as week 12 and was sustained for up to 54 weeks, Dr. Lambert concluded.

He added that the improvement in symptoms of depression and anxiety paralleled those in clinical measures of psoriasis.

Funding for the study was provided by Wyeth Pharmaceuticals Inc.

[Presentation title: Sustained Improvements in Depression and Anxiety Symptoms With Etanercept Therapy for Up to 54 weeks in Patients With Moderate to Severe Psoriasis: Results of the CRYSTEL Study. Abstract FP1359]

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