Adalimumab therapy for psoriasis in real-world practice: efficacy, safety and results in biologic-naive vs. non-naive patients

Background Patients and the course of treatment in daily practice are different from randomized controlled trials (RCTs). Objectives Primary objective: to analyse the percentage of patients achieving PASI 75. Secondary objectives: PASI 50, PASI 90, PASI 100 responses, the percentage of patients experiencing at least one serious adverse event (SAE) and the response in biologic-naive vs. non-naive patients. Methods Prospectively collected efficacy and safety data of a cohort of psoriasis patients treated with adalimumab in daily practice between May 2007 and July 2011 were analyzed. Efficacy was determined using an intention-to-treat analysis and an as treated analysis, in comparison with the course baseline PASI before the start of adalimumab and the original baseline PASI before the start of any biologic therapy. Results Eighty-five patients received adalimumab therapy with a mean treatment duration of 1.4 (range 0.023.1) years. Compared with the original baseline PASI, PASI 75 response rates at week 12 and 24 were 34% and 38% (ITT). PASI 75 responses were well maintained until week 132. Only the PASI 75 response rate at week 12 differed significantly between biologic-naive (56%) and non-naive patients (29%). Sixteen patients (19%) experienced 28 SAEs. Seven patients (8%) experienced SAEs considered possibly or probably related to adalimumab. Conclusions In this cohort, PASI75 responses were substantial but lower than in RCTs and other daily practice studies. Efficacy was well maintained during more than 2years of follow-up and differed only between biologic-naive and non-naive patients at week 12. The incidence of SAEs was low but seems higher than observed in RCTs.