Paul S Yamauchi1, Robert Bissonnette2, Henrique D Teixeira3, Wendell C Valdecantos3. 1. Dermatology Institute and Skin Care Center, Santa Monica, California; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California. Electronic address: paulyamauchi@yahoo.com. 2. Innovaderm Research, Montreal, Quebec, Canada. 3. AbbVie Inc, North Chicago, Illinois.
Abstract
BACKGROUND: Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure). OBJECTIVE: We sought to systematically investigate the efficacy and safety of a second TNF antagonist after failure of a first TNF antagonist. METHODS: Published primary studies evaluating the efficacy of switching TNF antagonists after failure were systematically extracted. RESULTS: Fifteen studies were included. Although response rates to a second TNF antagonist were lower than for a first, a substantial proportion of patients in every study achieved treatment success. Week-24 response rates for a second antagonist were 30% to 74% for a 75% improvement in Psoriasis Area and Severity Index score and 20% to 70% for achieving a Physician Global Assessment score of 0/1; mean improvements in Dermatology Life Quality Index ranged from -3.5 to -13. In general, patients who experienced secondary failure achieved better responses than patients with primary failure. Adverse event incidences ranged from 20% to 71%, without unexpected adverse events; 0% to 11% of patients experienced serious adverse events. LIMITATIONS: There was no common definition of treatment failure across these studies of varied design. CONCLUSIONS: Some patients benefit from switching to a second TNF antagonist after failure of a first TNF antagonist, with improved quality of life.
BACKGROUND:Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure). OBJECTIVE: We sought to systematically investigate the efficacy and safety of a second TNF antagonist after failure of a first TNF antagonist. METHODS: Published primary studies evaluating the efficacy of switching TNF antagonists after failure were systematically extracted. RESULTS: Fifteen studies were included. Although response rates to a second TNF antagonist were lower than for a first, a substantial proportion of patients in every study achieved treatment success. Week-24 response rates for a second antagonist were 30% to 74% for a 75% improvement in Psoriasis Area and Severity Index score and 20% to 70% for achieving a Physician Global Assessment score of 0/1; mean improvements in Dermatology Life Quality Index ranged from -3.5 to -13. In general, patients who experienced secondary failure achieved better responses than patients with primary failure. Adverse event incidences ranged from 20% to 71%, without unexpected adverse events; 0% to 11% of patients experienced serious adverse events. LIMITATIONS: There was no common definition of treatment failure across these studies of varied design. CONCLUSIONS: Some patients benefit from switching to a second TNF antagonist after failure of a first TNF antagonist, with improved quality of life.
Authors: Luigi Barrea; Francesca Nappi; Carolina Di Somma; Maria Cristina Savanelli; Andrea Falco; Anna Balato; Nicola Balato; Silvia Savastano Journal: Int J Environ Res Public Health Date: 2016-07-22 Impact factor: 3.390