Abstract
The aim of this study is to compare effectiveness and safety of Infliximab (INF), Etanercept (ETN), and Adalimumab (ADA) in patients with psoriatic arthritis (PsA) with inadequate response to a previous disease-modifying antirheumatic drug (DMARD). One hundred consecutive PsA patients with inadequate response to a previous DMARD entered this study. Clinical and laboratory assessment at baseline (T0) and 12 (T12) months were performed and included physical examination, vital signs, global Psoriasis Area and Severity Index (PASI; extension of psoriasis), tender joints count (TJC), swollen joint count, health assessment questionnaire (HAQ; questionnaire for measuring disability), and monitoring of adverse events (AEs). After enrolment, all patients were randomly given INF 5 mg/Kg every 6–8 weeks, ETN 50 mg weekly, or ADA 40 mg every other week. Baseline therapy with DMARD remained unchanged. Effectiveness was defined as percentage of ACR20 responders and as clinical remission and/or minimal disease activity at 12 months treatment. INF, ETN, and ADA all effectively controlled signs and symptoms of PsA. All variables tested showed at T12 for each treatment a significant variation from the baseline value. In particular, patients on INF and ADA showed the greatest improvement in terms of PASI, while patients on ETN showed the greatest improvement on TJC and HAQ. ACR response rates were 72% of patients on ETN, 70% of those on ADA, and 75% of those patients on INF. Occurrence of AEs was reported in 15% of the cases. Only two AEs in patients on INF were considered drug related, pneumonitis and thrombocytopenia, respectively. All tumor necrosis factor-α blockers significantly controlled signs and symptoms of PsA. An increased knowledge of the different profiles of these agents may help in optimizing their use.
Similar content being viewed by others
References
Wright V, Moll JMH (1971) Psoriatic arthritis. Bull Rheum Dis 21:627–632
Kane D, Stafford L, Bresnihan B, FitzGerald O (2003) A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 42(12):1460–1468
Soriano ER, McHugh NJ (2006) Therapies for peripheral joint disease in psoriatic arthritis. A systematic review. J Rheumatol 33(7):1422–1430
Salvarani C, Olivieri I, Pipitone N, Cantini F, Marchesoni A, Punzi L, Scarpa R, Matucci-Cerinic M, Italian Society for Rheumatology (2006) Recommendations of the Italian Society for Rheumatology for the use of biologic (TNF-alpha blocking) agents in the treatment of psoriatic arthritis. Clin Exp Rheumatol 24(1):70–78
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis. Arthritis Rheum 54:2665–2673
de Vlam K, Lories RJ (2008) Remission in psoriatic arthritis. Curr Rheumatol Rep 10(4):297–302
Sokoll KB, Helliwell PS (2001) Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. J Rheumatol 28(8):1842–1846
Buskila D, Langevitz P, Gladman DD, Urowitz S, Smythe HA (1992) Patients with rheumatoid arthritis are more tender than those with psoriatic arthritis. J Rheumatol 19(7):1115–1119
Gladman D, Mease PJ (2006) Towards International Guidelines for the management of Psoriatic Arthritis. J Rheumatol 33(7):1228–1230
Scarpa R, Peluso R, Atteno M, Manguso F, Spanò A, Iervolino S et al (2008) The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: results of a pilot randomized 6-month trial with methotrexate. Clin Rheumatol 27(7):823–826
Gladman D (2008) Adalimumab, etanercept and infliximab are equally effective treatments for patients with psoriatic arthritis. Nat Clin Pract Rheum 4(10):510–511
De Vlam K (2006) Efficacy, effectiveness and safety of etanercept in monotherapy for refractory psoriatic arthritis: a 26-week observational study. Rheumatology (Oxford) 45(3):321–324
Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P et al (2004) Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 50(7):2264–2272
Van der Heijde D, Schiff MH, Sieper J, Kivitz A, Wong RL, Kupper H et al (2009) Adalimumab effectiveness for the treatment of ankylosing spondylitis is maintained for up to 2 years: long-term results from the ATLAS trial. Ann Rheum Dis 68(6):922–929, published online 2008 Aug 12
Rudwaleit M, Rødevand E, Holck P, Vanhoof J, Kron M, Kary S et al (2009) Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study. Ann Rheum Dis 68(5):696–701
Coates LC, Fransen J, Helliwell PS (2010) Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 69(1):48–53
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Atteno, M., Peluso, R., Costa, L. et al. Comparison of effectiveness and safety of infliximab, etanercept, and adalimumab in psoriatic arthritis patients who experienced an inadequate response to previous disease-modifying antirheumatic drugs. Clin Rheumatol 29, 399–403 (2010). https://doi.org/10.1007/s10067-009-1340-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1340-7