The treatment of psoriasis with etanercept: An experience from South Kuwait

Background: Etanercept, a tumor necrosis factor antagonist, is an approved biologic agent for treatment of chronic plaque psoriasis in the United States and Europe. Objective: To observe the efficacy and safety profile of etanercept in patients with moderate to severe plaque psoriasis. Methods: In this retrospective study, 56 patients were treated with etanercept between May 2005 and May 2008. All patients were screened for tuberculosis. They were started on etanercept 50 mg twice a week (BIW) for 12 weeks followed by 25 mg BIW for another 12 weeks. Response to treatment was assessed by Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Patients were reviewed at 4-week intervals, when clinical response and adverse effects were noted and photographs taken. Results: Forty-nine patients (87.5%) had chronic plaque psoriasis, three (5.35%) were erythrodermic and four (7.15%) had palmoplantar psoriasis. At least 75% reduction in PASI was achieved in 52% of patients at week 12 and 64% at week 24. Mean percentage of improvement from baseline in DLQI at week 12 was 47.6%, reaching 79% at week 24. The percentage of patients in the DLQI category correlating with ‘no effect’ on quality of life increased from 3.6% at baseline to 66% at week24, while the percentage in the category correlating with ‘extremely large effect’ decreased from 16% at baseline to 1.8% at week 24. In our study, a correlation was noted between DLQI and PASI score before treatment as well as at week 12 and 24. The adverse effects and laboratory abnormalities were minor. Conclusions: Etanercept was effective and well tolerated for moderate to severe psoriasis. It can be used intermittently without rebound, with psoriasis responding again on reintroduction.