MedWire News: The efficacy of adalimumab to provide at least a 75% improvement in Psoriasis Area and Severity Index (PASI 75) score appears to be consistently strong across different subgroups of patients, subanalyses of the REVEAL study show.
Adalimumab was effective for moderate-to-severe psoriasis irrespective of gender, age, race, duration of psoriasis, weight, body mass index (BMI), prior use of systemic therapy, and history of psoriatic arthritis.
The Phase III REVEAL (randomized controlled evaluation of adalimumab every other week dosing in moderate-to-severe psoriasis trial) initially demonstrated a 71% PASI 75 response rate in 814 patients with moderate-to-severe psoriasis taking adalimumab for 16 weeks, compared with just 7% in patients taking placebo.
In the current post hoc subanalyses, PASI 75 score responses for adalimumab-treated patients were consistent across age groups, although nominally lower for patients aged 65 years and older, at 61% compared with 74% for patients younger than 40 years of age and 70% for patients aged 40-64 years.
As reported in the Journal of the American Academy of Dermatology, both men and women responded well to adalimumab, with PASI 75 response rates of 74% and 65%, respectively.
Duration also had no effect on adalimumab response, with rates of 68% for those who had psoriasis for less than 9.7 years and 73% for those who had suffered with the condition for at least 24.8 years.
"This suggests that in the patients with longer disease duration, psoriasis had not become refractory to treatment," explain Alan Menter and colleagues from Baylor University Medical Center, Dallas, Texas.
"Patients who had previously been treated with systemic oral and biological treatments also responded as well as patients who had not received these treatments," they add.
The results also demonstrated consistent PASI 75 response with adalimumab treatment across baseline disease characteristics, including PASI score, body surface area involvement, Physicians Global Assessment score, and history of psoriatic arthritis.
Weight and BMI had only modest effects on PASI response rate. Rates among individuals weighing 90 to less than 140 kg ranged between 61% and 68% compared with 73-81% for those weighing less than 60 to less than 90 kg. Similarly, obese people with a BMI of 30 kg/m2 or above had an average PASI 75 response rate of 65% compared with 79% for patients with a healthy BMI of 18.5-25.0 kg/m2.
In multivariate analysis of the findings, the treatment patients received, their weight, and their age were the most influential factors on the mean percentage change in PASI score at week 16.
Adalimumab therapy had an acceptable safety profile overall and for patients with a history of hypertension, hyperlipidemia, depression, obesity, and diabetes, with no difference in the risks for serious adverse events between patients taking placebo and those given adalimumab.
Given the relatively short duration of the trial and the fact that the data come from a clinical trial sample, the researchers call for longer-term study of data from large psoriasis/biologics registries.
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