Etanercept (ETN) treatment continuation in routine clinical practice may lead to benefits for remission and low disease activity among patients with psoriasis, psoriatic arthritis, or axial spondyloarthritis who did not achieve their treatment goals at 12 weeks, according to recent findings.¹

These findings resulted from a new study highlighting treatment impacts for those with rheumatic diseases and plaque psoriasis, looking at the period after 12 weeks of treatment with etanercept. This research was led by Eugen Feist from the department of rheumatology, Helios Fachklinik, Sophie-von-Boetticher-Straße 1, 39245, in Vogelsang-Gommern, Germany.

Feist and colleagues noted that prior research on rheumatic disease and psoriasis suggested disease remission rate benefits beyond 12 weeks.²

“The primary aim of this prospective, non-interventional study was to evaluate the proportion of patients with rheumatoid arthritis (RA), axSpA, PsA, or PsO who, in routine clinical practice, benefit from the continuation of treatment with etanercept (ETN) beyond 12 weeks, even in cases where the defined treatment goal has not been formally attained by week 12,” Feist and colleagues wrote. “Patient-reported outcomes were also recorded.”

Background and Findings

The ADEQUATE, as it was titled, was conducted with a prospective, multicenter, non-interventional design. The investigators carried out the study in Germany, evaluating the effectiveness of etanercept among those diagnosed with rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, or psoriasis.

The research team looked at routine treatment outcomes at the 12, 24, 36, and 52-week marks among the study participants. The treatment administration used by the team abided by the Summary of Product Characteristics (SmPC) guidelines, including warnings, contraindications, precautions, interactions, adverse effects, and dosing guidelines.

Data on study subjects was assessed for up to 52 weeks post-etanercept initiation. Treatment decisions made before enrollment in the study were also evaluated and documented during 5 12-weekly interactions.

As far as primary endpoints, the investigators looked at the proportion of individuals achieving remission and low disease activity by weeks 12 and then 24. They determined their secondary endpoints to be overall adverse event incidence, continuation of treatment despite non-remission at the 12-week mark, and certain patient-reported outcomes.

The research team determined their criteria for inclusion included having a confirmed diagnosis of the 4 aforementioned conditions, adherence to treatment SmPC guidelines, no previous treatment with etanercept (though other biologic treatments were allowed by the tea), and age ≥ 18 years. Their criteria for exclusion included contraindications as well as special warnings and precautions from the SmPC.

A total of 254 subjects with psoriatic arthritis, 305 with axial spondyloarthritis, and 70 with psoriasis took part in the study. The investigators found that rates of remission at both week 12 and week 24 were shown to be 19% and 18% for those with axial spondyloarthritis, 38% and 51% for those with psoriatic arthritis, and 7% and 19% for those with psoriasis, respectively.

Similarly, the research team found that rates of low disease activity at the specified points in time were 39% and 45% for axial, 50% and 60% for psoriatic arthritis, and 34% and 51% for psoriasis. An extension of treatment up to 52 weeks led to stable or increased rates of remission and low disease activity.

Furthermore, they found that improvements in fatigue, pain, and depression were noted by the investigators across all of the specified conditions. They did not identify new safety concerns during the course of the study.

“This study confirms the effectiveness and safety of ETN in a real-world setting and highlights the potential benefits of continuing treatment with ETN in patients with axSpA and PsA who have not reached their treatment goal after 12 weeks,” they wrote. “These results mirror those from the same study in patients with RA, demonstrating benefits of extended ETN treatment across a range of rheumatic diseases.”

References

1. ^{Feist, E., Baraliakos, X., Behrens, F. et al. Etanercept in Axial Spondyloarthritis, Psoriatic Arthritis, and Plaque Psoriasis: Real-World Outcome Data from German Non-interventional Study ADEQUATE. Rheumatol Ther (2024). https://doi.org/10.1007/s40744-023-00633-2.}
2. ^{Strohal R, Puig L, Chouela E, et al. The efficacy and safety of etanercept when used with as-needed adjunctive topical therapy in a randomised, double-blind study in subjects with moderate-to-severe psoriasis (the PRISTINE trial). J Dermatolog Treat. 2013;24(3):169–78.}