Adalimumab for moderate to severe psoriasis: an open-label, retrospective 3-year study

Adalimumab is a human, antitumour necrosis factor (TNF) monoclonal antibody with a high specificity and affinity for TNF-a but not for other cytokines, such as lymphotoxin (LFb). This drug is approved for the treatment of moderate to severe rheumatoid arthritis and recently it has also been approved for psoriatic arthritis and psoriasis. In fact in several controlled studies adalimumab was shown to be effective in both psoriasis and psoriatic arthritis with a rapid onset of action and a good safety profile. The aim of our study was to evaluate the efficacy and safety of monotherapy with adalimumab in patients affected by psoriasis and/or psoriatic arthritis for which previous conventional and/or biological treatments have failed. We treated 30 patients (18 males, 12 females). In 20 patients concomitant psoriatic arthritis was present. All patients were unresponsive or intolerant to conventional treatment (methotrexate, ciclosporin, retinoids, psoralen plus ultraviolet A radiation) and/or to at least one biological treatment. Adalimumab was administered at a dosage of 40 mg, subcutaneously, once a week. In 13 patients after 2 years of treatment the drug was administered at a dosage of 40 mg every other week. The efficacy was evaluated in all patients every 4 weeks by the determination of the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index (DLQI), the Psoriasis Disability Index (PDI), the Skindex-29 and the Health Assessment Questionnaire (HAQ) scores. Adalimumab was generally well tolerated. There were no reports of severe adverse events during the treatment period. Adalimumab treatment was effective and considerably improved patients’ PASI score and quality of life, as assessed by all four measures (DLQI, PDI, Skindex-29 and HAQ). In fact by week 12, 83% of the patients achieved PASI 75 and its efficacy continued to improve at week 24 with 89% of the patients reaching PASI 75. The efficacy was maintained for up to 3 years of treatment with 96% of the patients maintaining PASI 75. Our results suggest that among the new biologic therapies, adalimumab can be considered as a valuable alternative therapy for the treatment of psoriasis and psoriatic arthritis also in patients previously treated with other biological agents. Moreover adalimumab has shown a very good safety profile in the long term.