Targeted treatment of psoriasis with adalimumab: a critical appraisal based on a systematic review of the literature

Abstract

Psoriasis is a chronic inflammatory disease affecting 2% to 3% of the population in Western countries. Psoriasis is associated with limited quality of life, cardiovascular disease, and depression. The approval of injectable biological agents has revolutionized the management of moderate to severe psoriasis. Adalimumab is a human monoclonal antibody against tumor necrosis factor (TNF) alpha approved for moderate-to-severe plaque-type psoriasis and psoriatic arthritis (PsA). This systematic review summarizes the evidence concerning the efficacy, clinical effectiveness, safety, and cost-effectiveness of adalimumab in the treatment of psoriasis. Five randomized controlled trials demonstrated the efficacy of adalimumab in moderate-to-severe plaque-type psoriasis and PsA with PASI-75 response rates of 53% to 80% and ACR-20 response rates of 39% to 58% after 12 to 16 weeks of treatment. In clinical practice patients who have not responded to one TNF antagonist may respond to another TNF antagonist. Adalimumab has similar or better cost-effectiveness than other biologics, but is less efficient than methotrexate and cyclosporine. Adalimumab is generally well tolerated. Patients should be evaluated for active/latent tuberculosis, serious infections, and other contraindications prior to initiation of adalimumab therapy. Future studies should investigate the comparative efficacy of adalimumab and other biologic and prebiologic agents. Recently established registries will yield additional data on the effectiveness and long-term safety of adalimumab.

Modulation of Toll-like Receptors in Psoriatic Patients during Therapy with Adalimumab

“…It is a fully human monoclonal antibody IgG 1 against tumor necrosis factor alpha, which is able to interfere with the TNF-alpha activities (14)(15). It was seen that adalimumab is able not only to improve clinical conditions of psoriatic patients, but also to modulate TLR expression, recovering its expression as in healthy skin.…”

Adalimumab (Humira™): a promising monoclonal anti-tumor necrosis factor alpha in ophthalmology

“…Adalimumab has been approved for clinical use in moderate-to-severe plaque-type psoriasis and PsA. There is evidence concerning the efficacy, safety, and cost-effectiveness of adalimumab in the treatment of psoriasis; Schmitt and Wozel [29] reported that patients with moderateto-severe plaque-type psoriasis and PsA showed an important improvement within 12-16 weeks after the beginning of adalimumab treatment.…”

Staphylococcal Alpha-Toxin Is a Strong Inducer of Interleukin-17 in Humans

“…The effect of alpha-toxin was further amplified by upregulation of IL-1 in monocytes. In conclusion, higher levels of IL-17A secretion induced by alpha-toxin in the skin partially explain how colonization with S. aureus can contribute to chronic skin inflammation.Atopic dermatitis (AD) and psoriasis (PS) are the most common immune-mediated chronic inflammatory skin diseases, with an increasing prevalence, affecting approximately 1 to 4% of the population in industrial countries (8,36,39). One hallmark of AD is a striking susceptibility to colonization with Staphylococcus aureus: 80 to 100% of patients with AD are colonized with S. aureus (4, 27).…”

“…Atopic dermatitis (AD) and psoriasis (PS) are the most common immune-mediated chronic inflammatory skin diseases, with an increasing prevalence, affecting approximately 1 to 4% of the population in industrial countries (8,36,39). One hallmark of AD is a striking susceptibility to colonization with Staphylococcus aureus: 80 to 100% of patients with AD are colonized with S. aureus (4, 27).…”