At 6 months, quality of life is largely the same whether psoriasis patients stay on their initial etanercept (Enbrel) dose of 50 mg twice weekly or step down to 50 mg once weekly with topical corticosteroids, according to a Canadian trial published in the Journal of The European Academy of Dermatology and Venereology.
“The opportunity to use a topical agent seemed to improve [patients’] overall satisfaction,” and weekly “etanercept and topical may be a less costly option compared with” etanercept twice weekly, said the investigators, led by Dr. Kim Papp, of Probity Medical Research in Waterloo, Ont.
Previously, the investigators showed that the step-down strategy works as well as full-dose maintenance in clearing the skin. They wanted to check if that also held true for quality of life, as assessed by the Dermatology Life Quality Index (DLQI) and the Treatment Satisfaction Questionnaire for Medication (TSQM). (J Eur Acad Dermatol Venereol. 2015 Aug;29(8):1555-61).
The 287 patients, all with moderate-to-severe plaque psoriasis for at least half a year, received etanercept 50 mg twice weekly for 12 weeks; 144 were then randomized to stay on that dose, and 143 others to drop to 50 mg weekly with the addition of topicals as required through week 24. The mean age of patients in the trial was 45 years; 88% of the subjects were white and 65% were men.
Topicals included hydrocortisone 2.5%, beta methasone valerate 0.1%, betamethasone dipropionate 0.05%, clobetasol 0.05%, calcitriol, or calcipotriol plus betamethasone dipropionate 0.05%; the topicals were selected by the researchers, who were allowed to change them as needed.
The mean change in DLQI from baseline to week 24 was 10.7 points in the etanercept group and 9.9 points in the etanercept-plus-topical group. Mean change in TSQM effectiveness, convenience, side-effects, and global satisfaction was 27.1, 14.8, -0.7 and 26.7 points in the etanercept group, and 32.5, 18.5, 1.3, and 28.4 points in the etanercept-plus-topical group. Healthcare visits, employment status, work productivity, and ability to perform daily activities were similar between the treatment arms.
The study was descriptive; the investigators didn’t run statistical analyses. Even so, measures of quality of life “were numerically similar in patients who stayed on etanercept 50 mg [twice weekly] and patients who received etanercept 50 mg [weekly] plus topical therapies. No notable differences between treatment arms ... were observed. Additionally, improvements in [Psoriasis Area and Severity Index] scores appeared to correlate with improvements in patient reported outcomes,” the investigators said.
“The duration of treatment with topical therapies was only 12 weeks; a longer duration may result in loss of efficacy as adherence to topical therapies may decrease with time,” they noted.
The work was funded by etanercept’s maker, Amgen. Dr. Papp reported consulting for the company. Two other investigators have been Amgen advisors and reported research grants, speakers fees, or other payments.