Received: 12 March 2019 Accepted: 5 April 2019

DOI: 10.1111/dth.12936

THERAPEUTIC HOTLINE: SHORT PAPER

Efficacy of biologic therapies in psoriasis vulgaris

Ritjona Mala1 | Monika Fida2 | Ekleva Jorgaqi1 | Ermira Vasili2

1
Department of Dermatology, UHC "Mother
Teresa", Tirana, Albania Abstract
2
Department of Dermatology, University of Psoriasis is a chronic, immune-mediated skin disease that also has systemic manifestations.
Medicine, Tirana, Albania
Biologic preparates: Adalimumab, Etanercept, and Infliximab are licensed for psoriasis
Correspondence vulgaris treatment in Albania. To compare the efficacy of biologic therapies used for psori-
Monika Fida, Department of Dermatology,
asis based in our experience. A cohort prospective study during the years 2016–2018 at
University of Medicine, Tirana, Albania.
Email: monikafida@gmail.com UHC “Mother Teresa” Tirana. In the study took place 78 patient diagnosed with psoriasis
and treated with biologic therapies. Psoriasis Area Severity Index (PASI) 50 and PASI
75 index were the parameters of response outcomes. PASI 50 was achieved for 6.8, 7.02,
and 7.2 weeks in patients with Etanercept, Adalimumab, and Infliximab respectively and
PASI 75 for 12.8, 11.4, and 11.42 weeks. X2 = 0.076, p > .05, nonsignificant difference.
PASI 50 was achieved in 27.2% of subject treated with Etanercept, 67.4% Adalimumab,
and 55.5% with Infliximab for the weeks mentioned above. Meanwhile PASI 75 was
achieved in 45.4% of subject treated with Etanercept, 61.7% Adalimumab, and 25% with
Infliximab. X2 = 15.28, p < .05, significant difference. Biologics have revolutionized the
treatment of psoriasis. To select the most appropriate agent for patient, should be consid-
ered multiple factors including adverse effects, tolerance, patient preference, cost, and
mode of administration.

KEYWORDS
biologic therapies, PASI 50, PASI 75, psoriasis vulgaris

1 | B A C KG RO U N D Clinic in University Hospital Center “ Mother Theresa” Tirane,

Albania.
Psoriasis is a chronic, immune-mediated skin disease that also has systemic
manifestations. Safe and effective long-term treatments are needed (Furst,
3 | METHODS
Wallis, Broder, & Beenhouwer, 2006). Biologic treatments that inhibit the
immunopathogenesis of psoriasis have helped meet this need (Furst et al.,
Cohort prospective study during 2016–2018 at University Hospital
2006). Many biologics are used in our country for treatment of both der-
Center “Mother Teresa” Hospital, Dermatology Clinic. This study was
matologic and nondermatologic disease. Adalimumab, Etanercept, and
performed in 78 patient diagnosed with psoriasis, in which biologic
Infliximab are licensed for psoriasis vulgaris treatment in Albania.
therapies was indicated. Psoriasis Area Severity Index (PASI) 50 and
PASI 75 index were the parameters of response outcomes.
2 | PURPOSE

The purpose of this study was to compare the efficacy of biologic

4 | RESULTS
therapies used for Psoriasis based in our experience of Dermatology
Nine from 78 patients were treated with Infliximab, 44 with
A prospective observational cohort study in Albania. Adalimumb, and 25 with Etanercept. Average age of patient was for

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https://doi.org/10.1111/dth.12936
2 of 3 MALA ET AL.

TABLE 1 Demographic characteristic of patients Is there any difference in efficacy and safety between them? In our
study there is no significant difference in average time between these
Etanercept Adalimumab Infliximab
Characteristic (n = 25, 32%) (n = 44, 56%) (n = 9, 12%) three groups of patients to achieve PASI 75, but there is a significant
difference in percentage of them. PASI 75 in 16 weeks is achieved
Demographic (mean, SD for continuous variables; n, % cohort
for categorical variables) by 63% of patients treated with Etanercept, Adalimumab = 92% of
Age (years) 50.7, 45.18, 60.2, patients, Infliximab = 87.5% of patients. In other studies there are
SD = 13.65 SD = 14.9 SD = 6.4 mixed levels of evidence for the long-term efficacy of biologics. They
Female 15 (60%) 27 (61%) 2 (22%) conclude that treatment adherence and safety profile is good
Comorbidity 12(48%) 24 (54%) 5 (55%) (Chiricozzi et al., 2016).
Disease Why this difference? This difference is probably explained by the

Disease 19.09 15.87 19.22

structural differences between these biologic medicaments. Infliximab
duration (years) is a humanized mouse monoclonal antibody, Adalimumab a fully
PASI (average 28.2 27.03 36.7 human monoclonal antibody, and Etanercept a construct comprising
at start point) two human p75 TNF- receptors coupled to the Fc portion of a mono-
clonal human antibody (Mpofu, Fatima, & Moots, 2005). This lead to
Abbreviation: PASI, Psoriasis Area Severity Index.
pharmacokinetic differences. The monoclonal antibodies (Infliximab
and Adalimumab) have lower clearances, greater volumes of distribu-
T A B L E 2 Percentage of patient that achieve PASI 75 in 10, 12,
and 16 weeks tion, and longer half-lives than the soluble receptor (Etanercept) that
lead to efficacy difference (Furst et al., 2006). As physician we in our
PASI 75 10 weeks 12 weeks 16 weeks
day we are in challenge how and which to choose for our patient.
Etanercept 9% of patients 45% 63% Unfortunately there is no simple way. There is a growing list of bio-
Adalimumab 67% 75% 92% logic options to choose. “PASI-score” is not the only predictive param-
Infliximab 25% 50% 87.5% eter of treatment success (Vilarrasa et al., 2016). Adverse risk

Abbreviation: PASI, Psoriasis Area Severity Index. considerations, patient compliance, comorbidities, and unfortunately,
drug expense and insurance coverage should be considered while
group treated with Etanercept: 50.7 years, SD = 13.65, Adalimumab: choosing biologic therapy (Chiricozzi et al., 2016; Rønholt & Iversen,
45.18, SD = 14.9, and Infliximab: 60.2, SD = 6.4. Average disease 2017). Future studies on the mechanistic link of genetics and com-

duration of patients in therapy with Etanercept is: 19.09 years, orbidities to psoriasis may bring information that permits a more indi-
vidualized treatment approach (Vilarrasa et al., 2016). Antibodies
Adalimumab: 19.22, and Infliximab: 15.87 (Table 1).
therapeutic monoclonal antibodies or fusion proteins neutralizing
The average time needed to achieved PASI 50 was 6.8, 7.02, and
cytokines, cytokine subunits, or receptors will represent part of the
7.2 weeks for Etanercept, Adalimumab, and Infliximab, respectively,
2 future therapeutic armamentarium that will be completed by small
and PASI 75 for 12.8, 11.4, and 11.42 weeks. Chi-square X = 0.076,
molecule drugs (Chiricozzi et al., 2016). It is important to keep at cen-
p > .05, nonsignificant difference. There was a total of 27.2% of sub-
ter of care the patient all the time. We should consider the patient
ject treated with Etanercept, 67.4% Adalimumab and 55.5% with
preferences, such as mode of administration and access when choos-
Infliximab achieving PASI 50 for the weeks mentioned above. Mean-
ing the biologic therapy (Kim et al., 2012).
while there was a total of 45.4% of subject treated with Etanercept,
61.7% Adalimumab and 25% with Infliximab achieving PASI 75.
X2 = 15.28, p < .05, significant difference (Table 2).
6 | C O N CL U S I O N S
There was a loss of efficacy in 20% of patient treated with
Etanercept that did not response more to the treatment after
Biologics have revolutionized the treatment of psoriasis. There are
18 months, Adalimumab 9% of patients in 9 months, and Infiximab
found various levels of evidence for the long-term efficacy of bio-
33% of patients in 6 months.
logics. To select the most appropriate agent for patient, should be
considered multiple factors including adverse effects, tolerance,
patient preference, cost, and mode of administration.
5 | DISCUSSION

How effective are biologics? In this study it results that biologics therapy CONFLIC T OF INT ER E ST
have a considerable efficacy. PASI 75 in 16 weeks was: Etanercept in
63% of patients, Adalimumab in 92% of patients, and Infliximab in No conflict of interest for all authors.
87.5% of patients. In other studies PASI 75 responses range from 40 to
>90%. All biologics efficacy rates is superior compared to other thera-
OR CID
pies (Chiricozzi et al., 2016; Vilarrasa et al., 2016). Biologics are now a
major progress in treatment of moderate to severe psoriasis. Monika Fida https://orcid.org/0000-0001-8026-8995
MALA ET AL.
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How to cite this article: Mala R, Fida M, Jorgaqi E, Vasili E.
Efficacy of biologic therapies in psoriasis vulgaris. Dermatologic
Therapy. 2019;32:e12936. https://doi.org/10.1111/dth.12936