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Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial.
Br J Dermatol. 2008 Jun; 158(6):1345-9.BJ

Abstract

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Gisondi P
Department of Biomedical and Surgical Science, Section of Dermatology and Venereology, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy. paolo.gisondi@univr.it
Del Giglio M
No affiliation info available
Cotena C
No affiliation info available
Girolomoni G
No affiliation info available

MeSH

AcitretinAnti-Inflammatory Agents, Non-SteroidalChronic DiseaseDrug Administration ScheduleDrug Therapy, CombinationEtanerceptFemaleHumansImmunoglobulin GKeratolytic AgentsMaleMiddle AgedPilot ProjectsPsoriasisQuality of LifeReceptors, Tumor Necrosis FactorSingle-Blind MethodTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18410408

Citation

Gisondi, P, et al. "Combining Etanercept and Acitretin in the Therapy of Chronic Plaque Psoriasis: a 24-week, Randomized, Controlled, Investigator-blinded Pilot Trial." The British Journal of Dermatology, vol. 158, no. 6, 2008, pp. 1345-9.
Gisondi P, Del Giglio M, Cotena C, et al. Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial. Br J Dermatol. 2008;158(6):1345-9.
Gisondi, P., Del Giglio, M., Cotena, C., & Girolomoni, G. (2008). Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial. The British Journal of Dermatology, 158(6), 1345-9. https://doi.org/10.1111/j.1365-2133.2008.08564.x
Gisondi P, et al. Combining Etanercept and Acitretin in the Therapy of Chronic Plaque Psoriasis: a 24-week, Randomized, Controlled, Investigator-blinded Pilot Trial. Br J Dermatol. 2008;158(6):1345-9. PubMed PMID: 18410408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial. AU - Gisondi,P, AU - Del Giglio,M, AU - Cotena,C, AU - Girolomoni,G, Y1 - 2008/04/10/ PY - 2008/4/16/pubmed PY - 2008/8/21/medline PY - 2008/4/16/entrez SP - 1345 EP - 9 JF - The British journal of dermatology JO - Br J Dermatol VL - 158 IS - 6 N2 - 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. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/18410408/Combining_etanercept_and_acitretin_in_the_therapy_of_chronic_plaque_psoriasis:_a_24_week_randomized_controlled_investigator_blinded_pilot_trial_ DB - PRIME DP - Unbound Medicine ER -