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Relapse due to treatment interruption: retreatment in patients with psoriasis achieving response with Etanercept


In clinical practice, patients with psoriasis may require intermittent therapy as part of their long-term treatment programme. Those achieving Physician's Global Assessment ( PGA ) of less than or equal to 1 ( almost clear / clear ) are more likely to be selected as candidates for intermittent therapy than those with a higher PGA ( greater than or equal to 2; mild or worse ), who may relapse sooner or have a delayed response.

The objective of this analysis was to determine if patients achieving PGA less than or equal to 1 using intermittent Etanercept ( Enbrel ) therapy could regain response ( defined as PGA less than or equal to 2 ) after relapse.

In the CRYSTEL study, patients with moderate-to-severe psoriasis were treated with Etanercept 50 mg twice weekly ( BIW ) for less than or equal to 12 weeks ( or for an extra 12 weeks with Etanercept 25 mg BIW until PGA less than or equal to 2 was achieved ).
Patients who reached PGA less than or equal to 1 during this time were selected for this post hoc analysis ( Cycle 1 ). Treatment was paused, and patients who relapsed ( PGA greater than 2 ) were retreated with Etanercept 25 mg BIW until recovery ( PGA less or equal to 2, Cycle 2 ).
Treatment cycles were continued for up to 54 weeks. The proportion of PGA responders and the time to attain response were calculated, and patient satisfaction was evaluated using the Patient Satisfaction Survey.

During Cycle 1, 131 patients achieved PGA less than or equal to 1 within a median of 9 weeks and subsequently relapsed after treatment cessation.
In Cycle 2, 119 ( 91% ) patients attained PGA less than or equal to 2 within a median time of 7 weeks.

The majority of patients were either very satisfied, satisfied or somewhat satisfied during both Cycle 1 ( 100% in total ) and Cycle 2 ( 97% in total ).

In conclusion, patients achieving the stringent criteria of PGA less than or equal to 1 with Etanercept therapy before ceasing treatment, and subsequently relapsing, were able to quickly regain response during retreatment.
The majority of patients considered their therapy to be satisfactory. ( Xagena )

Griffiths CE et al, J Eur Acad Dermatol Venereol 2014; Epub ahead of print

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