Lower dose etanercept adequate for joint manifestations

Etanercept 50mg twice weekly is superior to 50mg once weekly in treating the skin manifestations of psoriasis and psoriatic arthritis but the two regimens have similar efficacy against joint manifestations, a study shows. In the double blinded study of almost 800 patients, 46% who received the drug twice a week had cleared or almost cleared their skin manifestations of psoriasis at week 12, compared with 32% of those who received the drug once a week. In contrast, there were no differences in response for arthritis symptoms, with 77% of those in the twice-weekly group and 76% of those in the once-weekly group meeting predetermined psoriatic arthritis response criteria at week 12. The PRESTA trial randomised patients to etanercept 50mg twice weekly (n=379) or 50mg once weekly (n=373) for 12 weeks. All subjects then received open label etanercept 50mg once weekly for 12 additional weeks. All patients were evaluated by dermatologists and rheumatologists. “The advantage of this co-operative strategy was supported by consistent measurement of outcomes for both psoriasis and psoriatic arthritis compared with previous disease specific trials,” they noted in the BMJ. The researchers concluded that 50 mg twice weekly followed by 50 mg weekly was an appropriate dose regimen for treating skin symptoms in psoriasis patients, whether or not they had concomitant psoriatic arthritis. On the other hand, they noted, at no time point was the twice weekly/once weekly regimen more advantageous in treating joint or tendon symptoms than the 50 mg once weekly dose regimen. The researchers said it was unclear why the higher dose cleared skin symptoms more rapidly than the low dose but did not have an additional benefit for the joint symptoms....