Etanercept is a new treatment for moderate to severe psoriasis. In contrast to traditional systemic agents, which can be given orally, etanercept is given by subcutaneous injection. Patient selection, transitioning, dosing, safety, monitoring, duration of therapy, and patient support programs are reviewed.
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References
1.
GuentherLLangleyRShearNH. Integrating biologic agents into management of moderate-to-severe psoriasis: A consensus of the Canadian Psoriasis Expert Panel. J Cutan Med Surg2004;8:321–37.
2.
Amgen and Wyeth Pharmaceuticals.Enbrel (etanercept) [prescribing information]. May 2006.
3.
KruegerGGFeldmanSRCamisaC. Two considerations for patients with psoriasis and their clinicians: What defines mild, moderate, and severe psoriasis? What constitutes a clinically significant improvement when treating psoriasis?J Am Acad Dermatol2000;43(2 Pt 1):281–5.
4.
CallenJPKruegerGGLebwohlM. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol2003;49:897–9.
5.
SterryWBarkerJBoehnckeWH. Biological therapies in the systemic management of psoriasis: International consensus conference. Br J Dermatol2004;151Suppl 69:3–17.
6.
LebwohlM. A clinician's paradigm in the treatment of psoriasis. J Am Acad Dermatol2005;53(1Suppl 1):S59–69.
7.
FeldmanSRKooJYMenterABagelJ. Decision points for the initiation of systemic treatment for psoriasis. J Am Acad Dermatol2005;53:101–7.
8.
FinlayAY. Current severe psoriasis and the rule of tens. Br J Dermatol2005;152:861–7.
9.
Hawkins-HoltM. Therapy with biologic agents is not associated with an increased risk of cancer recurrence in patients with rheumatoid arthritis. Poster presented at the American College of Rheumatology annual meeting; Orlando, Florida, 26 October, 2003. Poster #806.
10.
DominguezHStorgaardHRusk-MadsenC. Metabolic and vascular effects of tumor necrosis factor-alpha blockade with etanercept in obese patients with type 2 diabetes. J Vasc Res2005;42:517–25.
11.
AllenEHurleyYLeonardiC. Etanercept therapy in psoriasis patients with underlying hepatitis C. J Am Acad Dermatol2005;52:P1.
12.
ZeinNN. Etanercept as an adjuvant to interferon and ribavirin in treatment-naive patients with chronic hepatitis C virus infection: A phase 2 randomized, double-blind, placebo-controlled study. J Hepatol2005;42:315–22.
DonBRSpinGNestorovI. The pharmacokinetics of etanercept in in patients with end-stage renal disease on haemodialysis. J Pharm Pharmacol.2005;57:1407–13.
15.
ChambersCDJohnsonDLLyons JonesK. Pregnancy outcomes in women exposed to anti-TNF-alpha medications: The OTIS rheumatoid arthritis in pregnancy study [abstract]. Arthritis Rheum2004;50:S479–80.
16.
CushJJ. Biological drug use: US perspectives on indications and monitoring. Ann Rheum Dis2005;64:iv18–23.
17.
JacobSESergayAKerdelFA. Etanercept and psoriasis, from clinical studies to real life. Int J Dermatol2005;44:688–91.
18.
YamauchiPLoweNKooS. Cessation of cyclosporine therapy by treatment with etanercept in patients with severe psoriasis [abstract]. J Am Acad Dermatol2005;52:1.
19.
YamauchiPLoweNKooS. Etanercept therapy allows tapering of methotrexate and sustained clinical responses in patients with moderate to severe psoriasis [abstract]. J Am Acad Dermatol2005;52:185.
20.
O'DellJRPetersenKLeffR. Etanercept in combination with sulfasalazine, hydroxychloroquine, or gold in the treatment of rheumatoid arthritis. J Rheumatol2006;33:213–8.
21.
GrünkeMKaldenJRMangerBAntoniCE. Safety and efficacy of leflunomide plus etanercept combination therapy in patients with rheumatoid arthritis: Results from an open-label pilot study [abstract]. Ann Rheum Dis2005;64Suppl III:421.
22.
StoneJH. Etanercept plus standard therapy for Wegener's granulomatosis. N Engl J Med2005;352:351–61.
23.
WoodsonJ. Combination therapy with PUVA and etanercept in the treatment of severe psoriasis [abstract]. J Am Acad Dermatol2005;52:179.
24.
KircikLBagelJKormanN. Utilization of narrowband UVB light therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. Presented at: Summer Academy 2006 of the American Academy of Dermatology; July 26–30, 2006; San Diego, Calif. Poster P2325.
25.
KrellJM. Use of alefacept and etanercept in a patient whose psoriasis failed to respond to etanercept [abstract]. J Am Acad Dermatol2005;52:202.
26.
WeinblattMCombeBCovucciA. Safety of the selective costimulation modulator abatacept in rheumatoid arthritis patients receiving background biologic and nonbiologic disease-modifying antirheumatic drugs: A one-year randomized, placebo-controlled study. Arthritis Rheum.2006 Sep;54:2807–16.
27.
GenoveseMCCohenSMorelandL. Combination therapy with etanercept and anakinra in the treatment of patients with rheumatoid arthritis who have been treated unsuccessfully with methotrexate. Arthritis Rheum2004;50:1412–9.
28.
PappKATyringSLahfaM. A global phase III randomized controlled trial of etanercept in psoriasis: Safety, efficacy, and effect of dose reduction. Br J Dermatol2005;152:1304–12.
29.
DubertretL. Etanercept is an effective treatment for patients with psoriasis regardless of previous psoriasis systemic treatment. In: European Academy of Dermatology and Venereology. Third Spring Symposium. Third Spring Symnposium. May 19–22, 2005. Sofia, Bulgaria. Poster Ps6.
30.
CostanzoAPapoutsakiMMazzottaA. Previous biological therapies influence the rate of response to etanercept in chronic plaque psoriasis. In: 4th International Congress. The Royal College of Physicians. December 1–2, 2005. London, UK.
31.
TyringSPoulinYLangleyR. A 96-week phase 3 study of safety and efficacy of etanercept 50 mg twice weekly in patients with psoriasis. J Am Acad Dermatol2006;54:AB10.
32.
Serono Canada Inc.Raptiva (efalizumab) [product monograph] October 24, 2005.
33.
Biogen Inc.Amevive (alefacept) [product monograph] June 1, 2006.
34.
GordonKBGottliebABLeonardiCL. Clinical response in psoriasis patients discontinued from and then reinitiated on etanercept therapy. J Dermatolog Treat2006;17:9–17.
35.
LeonardiCLPowersJLMathesonRT. Etanercept as monotherapy in patients with psoriasis. N Engl J Med2003;349:2014–22.
36.
GardamMAKeystoneECMenziesR. Anti-tumour necrosis factor agents and tuberculosis risk: Mechanisms of action and clinical management. Lancet Infect Dis2003;3:148–55.
37.
WallisRSBroderMWongJBeenhouweD. Granulomatous infections due to tumor necrosis factor blockade: Correction. Clin Infect Dis2004; 39:1254–5.
38.
SmithCHAnstaeyAVBarkerJN. British Association of Dermatologists guidelines for the use of biological interventions in psoriasis 2005. Br J Dermatol2005;153:486–97.
39.
MutasimDFAdamsBB. A practical guide for serologic evaluation of autoimmune connective tissue diseases. J Am Acad Dermatol2000;42(2Pt 1):159–74; quiz 174–6.
40.
GilesJTBartlettSJGelberAC. TNF inhibitor therapy increases the risk of postoperative orthopedic infection in patients with rheumatoid arthritis [RA]Arthritis Rheum2006:15;55:333–7.
41.
BibboCGoldbergJW. Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int2004;25:331–5.
42.
ElkayamOGuspiDReitblattT. The effect of tumor necrosis factor blockade on the response to pneumococcal vaccination in patients with rheumatoid arthritis and ankylosing spondylitis. Semin Arthritis Rheum2004;33:283–8.
43.
KapetanovicMCSaxneTSjoholmA. Influence of methotrexate, TNF blockers and prednisolone on antibody responses to pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis. Rheumatology (Oxford).2006 Jan;45:106–11. Epub 2005 Nov 15.
44.
MeasePJRitchlinCTMartinRW. Pneumococcal vaccine response in psoriatic arthritis patients during treatment with etanercept. J Rheumatol2004;31:1356–61.
45.
National Psoriasis Foundation.Psoriasis: treatment options and patient management. National Psoriasis Foundation. http://www.psoriasis.org/about/stats/Viewed (accessed February 19, 2007).