Psoriasis: Etanercept recommendations

  • Indications: moderate to severe psoriasis,moderate to severe psoriatic arthritis, adult and juvenile rheumatoid arthritis(as young as 4 y), and ankylosing spondylitis
  • Dosing: 50 mg twice/wk given subcutaneously for3 mo followed by 50 mg once/wk
  • Short-term results: 49% of patients given 50 mg twice/wk achieved a PASI-75 at 12 wk; 34% of patients given 25 mg twice/wk achieved a PASI-75 at 12 wk
  • Step-down results: 54% of patients whose dose was decreased from 50 mg twice/wk to 25 mg twice/wk achieved a PASI-75 at 24 wk; 45% of patients whose dose remained at 25 mg twice/wk achieved a PASI-75 at 24 wk
  • Toxicities:
    • Mildly pruritic injection site reactions may occur
    • Rare cases of serious infections (ie, tuberculosis) and malignancies
    • There are also rare cases of drug-induced, reversible side effects including lupus without renal or CNS complications, cytopenia, MS, and exacerbation and new onset of CHF
  • Baseline monitoring:
    • PPD is required
    • LFT and CBC
  • Ongoing monitoring
    • Periodic history and physical examination are recommended while on treatment. Consider yearly PPD, and periodic CBC and LFT
  • Pregnancy category B
  • Contraindications: sepsis

Level of Evidence: I Strength of Recommendation: A


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Efficacy

Etanercept is a recombinant human TNF-α receptor (p75) protein fused with the Fc portion of IgG1 that binds to soluble and membrane-bound TNF-α.44,123 Etanercept has demonstrated efficacy in the treatment of several inflammatory diseases and is currently approved for treatment of moderate to severe plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, and ankylosing spondylitis. The dosing of etanercept differs in psoriasis than for its other indications. The approved regimen is 50 mg given subcutaneously twice weekly for the first 12 weeks followed by 50 mg weekly thereafter. Dosing is continuous.89 The efficacy of etanercept has been demonstrated in many clinical trials.32,44,124-126 At week 12 there was an improvement from baseline of PASI-75 or more in 34% of the etanercept group receiving 25 mg twice weekly and 49% of the etanercept group receiving 50 mg twice weekly, as compared with 4% of the patients in the placebo group (P < .001 for both comparisons with the placebo group).60,123,127,128 The clinical responses continued to improve with longer treatment. At week 24, there was at least PASI-75 in 44% of those in the 25 mg twice weekly group, and 59% in the 50 mg twice weekly group.127 Some patients will show a loss of clinical response after 12 weeks when the weekly dose is reduced from 50 mg twice weekly to 50 mg once weekly.

Navigate section 1 of the psoriasis guideline: Biologics

Citation note

When referencing this guideline in a publication, please use the following citation: Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008 May;58(5):826-50. 



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