Dosage Adjustments in Patients With Psoriasis on Etanercept: A Retrospective Chart Review

Abstract

Etanercept, 1 of 11 Food and Drug Administration (FDA)–approved biologics used for the treatment for psoriasis, may often be used at off-label dosages. The aim of this retrospective chart review was to determine the frequency of off-label dosing in a single center and the reasons for these deviations as well as the outcomes. The results of this study demonstrated that nearly two-thirds (64.7%) of patients treated with etanercept had some form of dosage adjustment during their treatment course. Dosage increases were reported most often; all were due to inefficacy of etanercept at the FDA-approved dosing. Interruptions and decreased dosages were reported among 36.4% and 18.2% of patients, respectively. Our study confirms previous data suggesting use of off-label doses of etanercept is commonplace, and a trial of increased etanercept dosing may be worthwhile for biologic-naive patients achieving suboptimal clinical response on standard dosing before switching to another biologic.

Dose Adjustment of Biologic Treatments for Moderate-to-Severe Plaque Psoriasis in the Real World: A Systematic Review

“…The administration of an increased dose while maintaining the interval was the most frequent strategy in the Carrascosa et al [ 7 ] study (80%). In contrast, most patients had a decrease in the dosing interval in the Lee et al [ 21 ] study. In the Egeberg et al [ 16 ] study, the proportion of patients on an escalated dose reduced from 39.0% during the first 24 weeks of treatment to 35.1% during maintenance therapy (25–52 weeks).…”

“…Long-term data (5 years of treatment) showed that etanercept dose escalations higher than the EMA label were higher at 5 years versus 1 year of treatment (71.4% vs 55.1%) [ 28 ]. All dose escalations in the Lee et al and Esposito et al [ 9 , 21 ] studies were because of inadequate efficacy. In the Lee et al [ 21 ] study, 30% of patients achieved better results with the 50 mg twice weekly dosing versus 25 mg twice weekly and two patients maintained this benefit when they reverted back to the lower dose.…”

“…All dose escalations in the Lee et al and Esposito et al [ 9 , 21 ] studies were because of inadequate efficacy. In the Lee et al [ 21 ] study, 30% of patients achieved better results with the 50 mg twice weekly dosing versus 25 mg twice weekly and two patients maintained this benefit when they reverted back to the lower dose.…”

“…In patients who had a dose reduction (10%) in the Sanz-Gil et al [ 24 ] study, dose was reduced to once every 2 weeks. Dose reductions (11.8%, n = 4) occurred less often than dose escalations in the retrospective chart review by Lee et al [ 21 ]. Motivations for dose reduction in the Esposito et al [ 9 ] study included prolonged remission (59.1%), patient choice (18.1%), other reasons (13.6%), or a concomitant event (9.1%).…”