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  • Title: [Efficacy of TNF-alpha antagonists for plaque-type psoriasis: a systematic review and graphical presentation].
    Author: Levy-Roy A, Porcher R, de Fonclare AL, Morel P, Dupuy A.
    Journal: Ann Dermatol Venereol; 2009 Apr; 136(4):315-22. PubMed ID: 19361697.
    Abstract:
    BACKGROUND: Numerous studies investigating the efficacy of TNF-alpha antagonists in moderate-to-severe plaque-type psoriasis have been published. We present a graphic synthesis of efficacy data based on a systematic review of the published studies. METHODS: The Medline, Embase and Cochrane Library bibliographic databases were searched for studies based on the following selection criteria: 1. Original studies, 2. Using infliximab, etanercept or adalimumab as the sole systemic treatment for plaque-type cutaneous psoriasis, 3. Minimum follow-up of 10 weeks, 4. Use of the PASI75 index (improvement of at least 75% from baseline PASI score) as an endpoint. Twenty-one articles were selected and PASI75 scores and corresponding 95% confidence intervals were calculated at three, six and 12 months. RESULTS: At M3, success rates were about 80% with infliximab and adalimumab once-weekly, around 50% with etanercept 50mg twice-weekly and adalimumab fortnightly; and 30% with etanercept 25mg twice-weekly. Maintenance regimens after three months ensured success rates above 50% with all three treatments, although the long-term results were based on fewer studies. CONCLUSION: Our graphic synthesis and tolerance data for the three drugs should guide clinicians in their therapeutic choices in moderate-to-severe plaque-type psoriasis. Additional studies with better reporting of loss to follow-up are needed to better assess the long-term efficacy of these drugs.
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