Psoriatic arthritis: Recommendations for the use of etanercept

  • Indications: Moderate/severe psoriatic arthritis, moderate to severe psoriasis, adult and juvenile rheumatoid arthritis (as young as age 4), and ankylosing spondylitis. 
  • Dosing for Psoriatic Arthritis: 25mg twice weekly or 50 mg once weekly given subcutaneously 
  • Response: ACR 20 at 12 weeks is 59%
  • 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: 1 Strength of Recommendation: A


Read more about these recommendations on efficacy

In a phase III study 205 PsA patients, etanercept showed significant improvement in signs and symptoms of psoriatic arthritis.27 Etanercept was administered subcutaneously at 25mg given twice weekly.  Significant improvement in all outcome measures was achieved with etanercept treatment, including the number of tender joints, swollen joints, morning stiffness, CRP levels, and both physician and patient global ratings.  In this study, 59% of etanercept patients as compared with 15% of placebo patients achieved an ACR20 response at 12 weeks (p < 0.0001).27   Response to etanercept was independent of concurrent methotrexate use (46% of patients in the study were using concurrent methotrexate at a mean dosage of 16 mg per week), although the numbers of patients in each cohort were too small to have adequate statistical power, similar to observations made in the adalimumab psoriatic arthritis trial.  Radiographic disease progression was inhibited in the etanercept group at 12 months; the mean annualized rate of change in the modified total Sharp score was -0.03 unit, compared with +1.00 unit in the placebo group (p = 0.0001).27  Of the 169 patients who participated in an open-label follow-up use of etanercept  between one and two years, the modified total sharp score in the 141 evaluable patients showed a change of -0.38 and -0.22 units in the original etanercept and placebo groups, respectively, indicating continued inhibition of joint structural damage.32  

References

27. Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P et al. Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 2004;50:2264-72.
32. Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P et al. Continued inhibition of radiographic progression in patients with psoriatic arthritis following 2 years of treatment with etanercept. The Journal of rheumatology 2006;33:712-21.

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Citation note

When referencing this guideline in a publication, please use the following citation: Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008 May;58(5):851-64.



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