Continuous Use of Adalimumab Recommended in Psoriasis Patients: Presented at EADV

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Title: Continuous Use of Adalimumab Recommended in Psoriasis Patients: Presented at EADV
URL: http://www.pslgroup.com/dg/22CDDE.htm
Doctor's Guide
September 19, 2008

By Jill Stein

PARIS -- September 19, 2008 -- Compared with intermittent treatment with adalimumab, continuous treatment with the drug produces better long-term outcomes in patients with psoriasis, researchers reported here at the 17th European Academy of Dermatology and Venereology (EADV) Congress.

Kim Papp, MD, Probity Medical Research Inc., Waterloo, Ontario, and colleagues conducted a study to determine whether interruption of adalimumab therapy altered efficacy outcomes in patients with moderate to severe psoriasis.

The study evaluated patients enrolled in the Randomized Controlled Evaluation of Adalimumab Every Other Week Dosing in Moderate to Severe Psoriasis Trial (REVEAL) study. The REVEAL study treated patients with moderate to severe plaque psoriasis with adalimumab 40 mg every 2 weeks.

Moderate to severe psoriasis was defined as a Psoriasis Area and Severity Index (PASI) score of 12 or greater, and an affected body surface area of at least 10%. All patients in the study had failed to respond to topical therapy and were naïve to tumour necrosis factor-antagonist therapy.

At week 33 of the trial, patients who achieved a 75% improvement from baseline in PASI score (PASI 75) were re-randomised in a double-blind manner to continued adalimumab or placebo. Patients who developed an inadequate response (<50% improvement in PASI score from baseline and at least a 6-point increase in PASI score relative to week 33) were eligible to receive adalimumab in an open-label extension phase. All patients who completed 52 weeks of the trial were eligible to receive adalimumab in the open-label extension.

In their present analysis, Dr. Papp and colleagues compared PASI 75 response rates between patients re-randomised to placebo or adalimumab at week 33 for patients who lost or did not lose adequate response during REVEAL, using data from week 24 of the open-label extension relative to baseline.

At the end of week 52, the loss of adequate response was significantly more frequent in patients who had been re-randomised to placebo versus adalimumab (28% vs 5%; P < .001).

In patients who were re-randomised to placebo, 55% of patients who lost an adequate response had PASI 75 compared with 84% of patients who did not lose an adequate response. For patients re-randomised to adalimumab, 55% of patients who lost adequate response had PASI 75 after 24 weeks of re-treatment in the open-label extension compared with 83% for patients who did not lose adequate response.

Overall, the findings support a role for continuous adalimumab therapy in psoriasis patients, Dr. Papp concluded. "Continuous therapy is needed to maintain an adequate therapeutic response over time," he noted.

Among patients who discontinued adalimumab therapy, those who lost an adequate response had poorer responses to subsequent retreatment versus those who had not lost an adequate response, he added.

Funding for the study was provided by Abbott Laboratories.

[Presentation title: Efficacy Outcomes for Patients With Psoriasis Who Interrupt Adalimumab Therapy. Abstract FP1384]

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