Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial

被引:100
作者
Gisondi, P. [1 ]
Del Giglio, M. [1 ]
Cotena, C. [1 ]
Girolomoni, G. [1 ]
机构
[1] Univ Verona, Sect Dermatol & Venereol, Dept Biomed & Surg Sci, I-37126 Verona, Italy
关键词
acitretin; chronic plaque psoriasis; combination therapy; etanercept;
D O I
10.1111/j.1365-2133.2008.08564.x
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background Combination treatments may increase efficacy while reducing dosages and side-effects of individual agents. No randomized controlled trials have been published combining biologics with conventional agents for psoriasis. Objectives To investigate the efficacy and safety of the association of acitretin and etanercept in the treatment of moderate to severe chronic plaque psoriasis. Methods A 24-week, randomized, controlled, investigator-blinded pilot trial was conducted. Sixty adult patients with moderate to severe chronic plaque psoriasis were randomized into three groups to receive etanercept 25 mg twice weekly subcutaneously, oral acitretin 0.4 mg kg(-1) daily or etanercept 25 mg once weekly plus acitretin 0.4 mg kg(-1) daily. The primary end point was a 75% or greater improvement in Psoriasis Area and Severity Index (PASI) from baseline (PASI 75) at week 24. Results At week 24, PASI 75 response was achieved by 10 of 22 patients in the etanercept group (45%), six of 20 in the acitretin group (30%) and eight of 18 (44%) in the group treated with etanercept plus acitretin (P = 0.001 for both etanercept groups compared with acitretin alone). A 50% or greater improvement from baseline in PASI was achieved by 15 of 22 (68%), 10 of 20 (50%) and 12 of 18 (67%) patients, respectively (P = 0.001). The safety profiles of the three groups were similar. Conclusions A combined therapeutic regimen with etanercept 25 mg once weekly and acitretin 0.4 mg kg(-1) daily is as effective as etanercept 25 mg twice weekly, and more effective than acitretin alone. Although larger studies are needed to confirm these results, the etanercept/acitretin association could offer several advantages in the therapy of moderate to severe chronic plaque psoriasis.
引用
收藏
页码:1345 / 1349
页数:5
相关论文
共 28 条
[11]  
Gisondi Paolo, 2004, Current Drug Targets - Inflammation and Allergy, V3, P175, DOI 10.2174/1568010043343903
[12]   Retinoids [J].
Gollnick, HPM ;
Dummler, U .
CLINICS IN DERMATOLOGY, 1997, 15 (05) :799-810
[13]   Combination therapy with acitretin for psoriasis [J].
Hodulik, SG ;
Zeichner, JA .
JOURNAL OF DERMATOLOGICAL TREATMENT, 2006, 17 (02) :108-111
[14]  
KRAGBALLE K, 1989, ACTA DERM-VENEREOL, V69, P35
[15]   Combination therapy to treat moderate to severe psoriasis [J].
Lebwohl, M ;
Menter, A ;
Koo, J ;
Feldman, SR .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 2004, 50 (03) :416-430
[16]   Acitretin in combination with UVB or PUVA [J].
Lebwohl, M .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1999, 41 (03) :S22-S24
[17]   Etanercept as monotherapy in patients with psoriasis [J].
Leonardi, CL ;
Powers, JL ;
Matheson, RT ;
Goffe, BS ;
Zitnik, R ;
Wang, A ;
Gottlieb, AB ;
Bagel, J ;
Camisa, C ;
Caro, I ;
DiGiovanna, JJ ;
Dunlap, FF ;
Elewski, BE ;
Gribetz, CE ;
Farber, HF ;
Feldman, SR ;
Frankel, EH ;
Gaspari, AA ;
Goodman, JJ ;
Gordon, KB ;
Hampel, FC ;
Herdener, RS ;
Hoffman, MD ;
Humeniuk, JM ;
Johnson, SM ;
Kang, S ;
Kimball, AB ;
Kirsner, RS ;
Korman, NJ ;
Krueger, GG ;
Kuwahara, RT ;
Lebwohl, M ;
Ling, MR ;
Liu, DC ;
Lowe, N ;
McCall, CO ;
Menter, A ;
Miller, BH ;
Moore, JK ;
Nayak, AS ;
Ratner, PH ;
Savin, RC ;
Shupack, JL ;
Smith, SL ;
Stone, SP ;
Swinehart, JM ;
Taborn, J ;
Tschen, EH ;
Weinstein, GD ;
Werth, VP .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (21) :2014-2022
[18]   ACITRETIN PLUS UVB THERAPY FOR PSORIASIS - COMPARISONS WITH PLACEBO PLUS UVB AND ACITRETIN ALONE [J].
LOWE, NJ ;
PRYSTOWSKY, JH ;
BOURGET, T ;
EDELSTEIN, J ;
NYCHAY, S ;
ARMSTRONG, R .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1991, 24 (04) :591-594
[19]   Psoriasis 2 - Current and future management of psoriasis [J].
Menter, Alan ;
Griffiths, Christopher E. M. .
LANCET, 2007, 370 (9583) :272-284
[20]   Reciprocal TH17 and regulatory T cell differentiation mediated by retinoic acid [J].
Mucida, Daniel ;
Park, Yunji ;
Kim, Gisen ;
Turovskaya, Olga ;
Scott, Iain ;
Kronenberg, Mitchell ;
Cheroutre, Hilde .
SCIENCE, 2007, 317 (5835) :256-260