Psoriasis is a relatively frequent...

Psoriasis is a relatively frequent condition, affecting about 2 percent of someones worldwide, and can be debilitating. Many treatments for psoriasis have a cumulative toxicity that limits their usefulness. Leonardi and colleagues report onward the use of etanercept, a synthetic protein that binds an inflammatory signal protein, in the treatment of psoriasis.

Adults with moderate to strict psoriasis that required phototherapy or systemic treatment were eligible for the thought A total of 652 patients received at least undivided dose of the study medication. Sixty-seven percent of the participants were male, 87 percent were white, and the mean age was 451 years. The reflection was sponsored by Immunex-Wyeth, the manufacturers of etanercept. Patients were randomized to twice-weekly self-administered injections of placebo or low-dosage (25 mg once-weekly), medium-dosage (25 mg twice-weekly), or high-dosage etanercept (50 mg twice-weekly) for 24 weeks. manage patients were crossed over to medium-dosage etanercept after 12 weeks.

Psoriasis severity was scored after 12 weeks of treatment. Compared with manage patients, statistically significant improvements were establish in patients receiving etanercept. An improvement of at least 75 percent in a psoriasis area-and-severity index was noted in 4 percent of mastery patients, 14 percent of patients who received low-dosage etanercept, 34 percent of patients who received medium-dosage treatment, and 49 percent of patients who received high-dosage treatment. After 24 weeks of treatment, there was at least a 75 percent improvement in 25 percent of patients receiving low-dosage treatment, in 44 percent of patients receiving medium-dosage treatment, and in 59 percent of patients receiving high-dosage treatment. Life-quality scores and patient-reported global assessment also improved.

The greatest in number common side effect was an injection site reaction, noted by means of 14 to 20 percent of patients taking the subject of attention drug over 24 weeks. The incidence of these reactions did not correlate with the dosage of etanercept. A total of 27 patients withdrew from the trial because of adverse general intents and 16 others withdrew because of lack of treatment efficacy. There were no reported cases of tuberculosis or other serious infection during the trial.

The authors bring to an end that etanercept is well tolerated and useful, in a dosage-responsive fashion, in the treatment of moderate to stern psoriasis.

Leonardi CL et al. Etanercept as monotherapy in patients with psoriasis. N Engl J M November 20 2003;349: 2014-22

EDITOR'S NOTE: The substantial benefit noted in patients who used etanercept for treatment of psoriasis is not surprising, given the drug's proven efficacy in other chronic inflammatory conditions (eg rheumatoid arthritis). As with mostly things in medicine, however, there is no "free lunch" Knocking disclosed tumor necrosis factor disables a solution signal in abnormal inflammation and normal, vital immune rule function. Serious infections and sepsis have been reported in patients using etanercept. Enthusiasm for widespread use also will be assuageed by etanercept's substantial cost (approximately $1300 by month for the medium dosage used in this contemplation based on average wholesale prices in R work Montvale, N.J.: Medical Economics Data, 2004) Still, it likely will have an increasing part in the treatment of patients with strict psoriasis that is refractory to usual treatment measures.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group