Etanercept in the treatment and retreatment of psoriasis in daily clinical practice.

Etanercept is a tumor necrosis factor alfa (TNFalpha) antagonist whose efficacy and safety in the treatment of psoriasis have been proven in many clinical trials. Nevertheless, few studies evaluate the efficacy and safety of this therapy in patients after discontinuation and readministration. Our study aimed to evaluate the efficacy and safety of etanercept in daily clinical practice for the treatment of patients with moderate-to-severe plaque psoriasis. The study also examines the discontinuation and readministration of the treatment. We carried out a retrospective observational study that collected data on 66 patients with moderate-to-severe psoriasis treated with etanercept at 25 mg or 50 mg twice weekly (BIW) at intermittent intervals over a period of 3.4 years. The following variables were evaluated during each of the retreatment cycles: outcome of the psoriasis area severity index (PASI) [PASI 50, PASI 75, and PASI 90], joint pain, and nail involvement. A significant fall in the PASI during each treatment cycle was observed. During cycle 1, the evaluation of the PASI was significantly lower for patients who started treatment with 50 mg BIW at weeks 12 and 24, even after the dose was reduced at week 12. After each treatment cycle was completed, the mean time to relapse was 3 months. When treatment was reintroduced after a relapse, the response rate was similar to that observed in the initial cycle. Joint pain and nail involvement improved significantly in each of the treatment cycles. In no case did we observe a relapse after therapy was interrupted, conversion of the morphology of psoriasis, or severe adverse events. We conclude that clinical efficacy and safety are maintained over time, and in the successive retreatment cycles. The interest of our study lies in the fact that several cycles of reinitiation and discontinuation of treatment are examined.