Low-Dose Strategy for Etanercept in Psoriatic Arthritis Can Maintain Remission

Recent evidence has shown that increasing intervals between etanercept (ETN) administration could effectively manage remission with a stable dose in patients with psoriatic arthritis (PsA) who had achieved remission with 25 mg ETN biweekly. Now, Italian researchers report that 72% of their trial participants being treated for PsA achieved sustained remission with ETN 25 mg biweekly, which was maintained a year after treatment initiation.

They note that remission was maintained in their open-label study in 54 patients diagnosed with PsA despite a progressive dose-reduction strategy that was created by increasing the dosing interval (21% with a weekly regimen and 51% with an every-other-week regimen). The findings were published in the Journal of Clinical Rheumatology by Renato de Stefano, MD, and colleagues.

All patients in the study had confirmed, active PsA, despite conventional treatment (synthetic disease-modifying antirheumatic drugs [DMARDs], nonsteroidal anti-inflammatory drugs, and corticosteroids], disease duration of more than 1 year, and were between 18 and 65 years old. They were recruited between September 2012 and June 2015 and followed for 1 year; participants were evaluated at baseline, 3 months, and every 1 month thereafter. The primary study endpoint was the proportion of patients in sustained clinical remission at week 48 with weekly ETN 25-mg therapy and with every-other-week ETN 25-mg therapy.

At the end of the study period, 27 patients (93%) remained in remission: 6 (21%) with a biweekly regimen, 6 (21%) with a weekly regimen, and 15 (51%) with an every-other-week regimen. More patients with peripheral oligoarthritis (7/16 patients; 44%) and axial PsA (5/12; 42%) than with peripheral polyarthritis (3/26, 11%) achieved clinical remission among those with an every-other-week regimen (P <.001).

There were no statistically significant differences in the incidence of adverse events (AEs) between the group of patients receiving biweekly ETN therapy and every-other-week ETN therapy. Baseline characteristics associated with a major clinical response to ETN were shorter disease duration, higher levels of C-reactive protein, and a higher Bath Ankylosing Spondylitis Disease Activity Index. However, none of these parameters reached statistical significance.

Etanercept dosage reduction was not associated with a reduction in AEs in the study, but the investigators said further investigation of longer duration is needed to confirm this finding. They noted that their study was limited by its open-label design, small sample size, and short duration of study.

The researchers conclude that it is possible to increase the ETN dosing interval in patients with remitting PsA initially treated with standard doses--especially patients with axial PsA or peripheral joint oligoarthritis and moderate cutaneous manifestations. “It seems natural that a progressive dose reduction of biological agents should play a crucial role in the therapeutic strategy of PsA,” they note. “Our results are in [agreement with] clinical practice commonly used in many rheumatology services.”

Reference

De Stefano R, Frati E, De Quattro D, de Stefano L. Low doses of etanercept can be effective to maintain remission in psoriatic arthritis patients. J Clin Rheumatol. 2018;24:127-131.