Baseline anti-dsDNA concentrations and previous treatments predict response to Adalimumab and Etanercept: A retrospective investigation of 146 psoriasis patients
Introduction
Adalimumab, a humanized monoclonal anti-tumor necrosis factor-α (TNF-α) antibody, and Etanercept, a soluble decoy receptor for TNF-α, are two commonly used biologics to treat patients with moderate to severe psoriasis. While the treatment is beneficial for many patients, treatment itself is expensive (approximately 23,000 € per patientyear for Adalimumab and 23–28,000 € per patientyear for Etanercept for medication alone [1]), has potential serious-side-effects (SSE), and maybe subject to loss-of-response (LOR). Both, Adalimumab and Etanercept, share very common medical indications in the treatment of psoriasis patients [1], [2]. Reliable methods to select among these treatments on an individual patient level are unavailable. We previously reported baseline anti-double-stranded DNA (anti-dsDNA) concentrations and anti-nuclear antibody titers (ANA) as potential predictors for LOR to Infliximab therapy and Infliximab-antibody formation [3]. While comparable modes of action exist among the aforementioned biologics, respective data on predictors of response to Adalimumab and Etanercept-treatment is lacking to date.
The present study investigated patient characteristics, previous treatments, and baseline laboratory parameters, including autoantibodies, that might predict response to Adalimumab and Etanercept-treatment using long-term real-life data.
Section snippets
Patient selection
Data of 356 patients treated at the outpatient clinic of the department of dermatology of the University of Heidelberg between March 2003 and January 2012 were retrospectively investigated. Patients were eligible for study participation if they were (A) treated with Adalimumab or Etanercept for psoriasis vulgaris (PV), psoriasis guttata (PG), psoriasis palmoplantaris pustulosa (PPP) with or without accompanying psoriasis arthritis (PA) at our institution, and (B) gave informed consent to
Study population
One hundred forty-six psoriasis patients treated at our immunological outpatient clinic with either Adalimumab or Etanercept were included in this study. Thirty-four of these patients were consecutively treated with Adalimumab and Etanercept at our institution and contributed data to both biologics. Please refer to Table 1 for further details on our general study population. Baseline anti-dsDNA values were available for 51 patients. Patient characteristics were similar to those of the general
Discussion
This study examined possible predictors of LOR/SSE under treatment with Adalimumab and Etanercept using long-term real-life data.
Kaplan–Meier curves were chosen to describe treatment response as event-free drug survival. Cox-regression analysis was used to identify possible predictors for LOR/SSE, thus accounting for right-censoring. LOR/SSE was chosen as a surrogate for overall treatment response over PASI 75 as LOR/SSE reflects joint and skin symptoms as well as adverse events and could be
Conclusions
Our data suggests that treatment with Adalimumab may promise best results in psoriasis-patients with (A) low baseline anti-dsDNA concentrations, and (B) no previous TNF-α antagonist treatment. Furthermore, our data suggests that age and baseline PASI do not predict response to Adalimumab and Etanercept treatment in a clinically significant manner. Further prospective research, particularly on baseline anti-dsDNA and sequential treatment with Adalimumab following Etanercept, is; however,
Funding sources
None.
Conflict of interest statement
The authors have no conflict of interest to declare.
Acknowledgements
We thank Mr. Lorenz Uhlmann of the Institute for medical biometry and informatics (IMBI) of the University of Heidelberg for statistical advice.
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