John Libbey Eurotext

European Journal of Dermatology

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Outcome following a short period of adalimumab dose escalation as rescue therapy in psoriatic patients Article à paraître

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Auteurs
1 Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna,
2 Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena,
3 Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona,
4 Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia,
5 Clinica Dermatologica, Dipartimento di Medicina e Chirurgia, Universita’ degli Studi di Parma,
6 Dermatology Unit, INRCA IRCCS Ancona,
7 UOC of Dermatology, Carlo Urbani Hospital, ASUR Marche AV2, Jesi, Ancona,
8 UOC of Dermatology, Hospital of Macerata, ASUR Marche AV3, Macerata,
9 UOC of Dermatology INRCA/IRCCS, Ancona, Italy
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Background: Advances in biologic treatments have led to a new therapeutic frontier for moderate-to-severe psoriasis. Nevertheless, the efficacy of anti-TNFα decreases with time, requiring adjustments to maintain valuable Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) responses. Objectives: To evaluate the efficacy and safety of adalimumab dose escalation (40 mg, subcutaneous, once a week for 24 weeks) in psoriatic adult patients with secondary loss of response (PASI ≥50 to ≤75 or PASI≥75 and DLQI ≥5). Materials and methods: A multicentre, observational study involving different Italian third-level referral centres for psoriasis enrolled a total of 64 adult patients with moderate-to-severe psoriasis who were treated with adalimumab and experienced a secondary loss of response. Primary end-points were PASI> 75 or PASI ≥50 to ≤ 75 with DLQI ≤ 5, and the secondary end-point was the ability to maintain a therapeutic response, resuming adalimumab every other week. Results: At Week 16 and Week 24, 29/64 (45.3%) and 35/64 (54.6%) responded based on PASI, and mean DLQI was 4.9 and 4.09, respectively. At Week 36 and Week 48, 45.3% and 28.1% patients achieved the second end-point, respectively. No adverse events were recorded except for one patient with recurrent tonsillitis. Conclusion: Adalimumab escalation could be considered in cases with loss of response before switching to alternative biologic therapy.