Efficacy and safety of etanercept in the treatment of recalcitrant psoriasis: An open-label, retrospective, observational study in Taiwan

Background: Psoriasis is a chronic inflammatory disease affecting the quality of life of patients. Traditional treatments are limited by adverse side effects. Etanercept is a biological agent used as an alternative treatment for psoriasis. Methods: This open-label, observational study conducted in Taiwan involved 22 patients with recalcitrant psoriasis who received a 24-week treatment with etanercept-50 mg twice weekly (BIW) during the first 12 weeks and 25 mg BIW in the next 12 weeks. Psoriasis Area and Severity Index (PASI) score at Weeks 0, 12, and 24 were recorded. Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibody (ANA), and tumor necrosis factor-alpha (TNF-alpha) at baseline, Week 12, and Week 24 were obtained. Adverse events and blood tests were recorded as safety assessment. Results: At Week 12, 54.5% and 13.6% patients achieved >= 50% improvement from baseline in PASI score (PASI 50 and PASI 75, respectively); at Week 24, 66.7% and 23.8% patients achieved PASI 50 and PASI 75, respectively. The mean improvement in PASI was 49.8% at Week 12 and 59.8% at Week 24, while 100% and 62.5% patients had reduced ESR and CRP levels, respectively. There were no deaths or serious adverse events. Four patients developed positive ANA, one of whom had poor psoriasis control. Most patients (93.8%) had higher serum TNF-alpha levels compared to baseline. Conclusions: Etanercept is effective and safe in treating recalcitrant psoriasis, reduces ESR and CRP levels, and occasionally induces positive ANA titer associated with poor psoriasis control. Serum TNF-alpha level may increase after treatment, but this does not seem to affect PASI improvement. Copyright (C) 2012, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved.