Psoriasis etanercept

Systemic therapies are seldom used for mild to moderate psoriasis, and are generally reserved for patients with moderate to severe psoriasis.17 29 Oral agents include sulfasalazine, acitretin, methotrexate, cyclosporine, mycophenolate mofetil, azathioprine, tacrolimus, and hydroxyurea. Parenteral agents include the biologic response modifiers alefacept, efalizumab, etanercept, infliximab, and many others, currently at various stages of research or approval for psoriasis. 

Etanercept is a fully human dimeric fusion protein composed of human TNF-a p75 receptor fused to the Fc portion of human IgG 1.41 It acts as a tumor necrosis factor-a (TNF-a) inhibitor by binding to and inactivating TNF-a, thus preventing interactions with its cell surface receptors.41 This agent is useful for chronic moderate to severe plaque psoriasis and for psoriatic... 

Several pro-inflammatory cytokines, such as TNFa, IL-1, IL-6, are important in the initiation and maintenance of various autoimmune diseases, such as RA, CD, and psoriasis. Thus, targeted therapies, which have been developed to inhibit their activity, have resulted in clinical improvement of these patients. Currently, there are three TNFa inhibitors (etanercept, infliximab, and adalimumab) and one IL-1 receptor antagonist (anakinra) that have been approved for the treatment of at least one of these diseases. In addition, a number of other anti-cytokine therapies are in clinical development. The TNFa antagonists will be reviewed here. 

Leonard CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl] Med 2003 349 2014-22. 

Plaque psoriasis (adults) 50 mg dose given twice weekly (administered 3 or 4 days apart) for 3 months followed by a reduction to a maintenance dose of 50 mg per week. Starting doses of etanercept 25 or 50 mg per week were also shown to be effective. 

Etanercept is a recombinant human soluble tumor necrosis factor-alpha (TNFo ) receptor fusion protein that binds to TNFo and decreases its role in disorders involving excess inflammation. It is approved for subcutaneous use in the treatment of patients with moderate to severe active rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing arthritis and plaque psoriasis. To the adverse reactions mentioned for infliximab, rare reports of congestive heart failure should be added. 

Infliximab is a monoclonal antibody against TNF-a (see Chapter 26, Section III.d.1). It has been approved for the treatment of psoriasis, Crohn s disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and ulcerative colitis. Similar immunosuppressants are etanercept, and adali-mumab. 

Etanercept is approved in the United States for the treatment of psoriatic arthritis and rheumatoid arthritis. Although etanercept has not been specifically approved for the treatment of the cutaneous manifestations of psoriasis, it significantly improves the skin lesions of patients with moderate to severe cutaneous psoriasis who have used it for psoriatic joint disease. 

Weinberg JM et al Biologic therapy for psoriasis An update on the tumor necrosis factor inhibitors infliximab, etanercept, and adalimumab, and the T-cell-targeted therapies efalizumab and alefacept. J Drugs Dermatol 2005 4 544. [PMID 16167412]... 

Biologic agents useful in treating adult patients with moderate to severe chronic plaque psoriasis include the T-cell modulators alefacept and efalizumab, and the TNF-a inhibitors etanercept, infliximab, and adalimumab. TNF-a inhibitors are also discussed in Chapter 55. 

Enbrel Etanercept Amgen 11/1998 Moderately to severely active rheumatoid arthritis/ polyarticular course juvenile rheumatoid arthritis/ psoriasis CHO... 

Feldman SR, BGmball AB, ueger GG, Wooley JM, Lalla D, Jahreis A (2005) Etanercept improves the health-related quality of life of patients with psoriasis Results of a phase HI randomized clinical trial. J Am Acad Dermatol 53 887-889. 

Nestorov I, Zitnik R, Ludden T (2004) Population pharmacokinetic modeling of subcutaneously administered etanercept in patients witli psoriasis. J Pharmacokirretic Pharmacodyn 31(6) 463 90. 

Sukal SA, Nadiminti L, Gransteirr RD (2006) Etanercept and demy-elinating disease in patierrts with psoriasis. J Am Acad Dermatol 54(1) 160-164. 

Krueger GG, Langley RG, Finlay AY, Griffiths CE, Wooley JM, LaUa D, Jahreis A (2005) Patient-reported outcomes of psoriasis improvement with etanercept therapy Results of a randomized phase ni trial. Br J Dermatol 153(6) 1192-1199. 

Etanercept Enbrel (Amgen) Rheumatoid arthritis psoriatic arthritis psoriasis ankylosing spondylitis juvenile rheumatoid arthritis... 

Lee A, Kasama R, Evangelista A, Elfenbein B, Falasca G Henoch-Schonlein purpura after etanercept therapy for psoriasis, J Clin Rheumatol 2006,12 249-251... 

---