Psoriasis Unit, Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.
J Eur Acad Dermatol Venereol. 2010 Dec;24(12):1413-20. doi: 10.1111/j.1468-3083.2010.03661.x.
Use of biological agents has been shown to be an efficacious approach in psoriasis, when traditional treatments fail. However, there are limited data on the effectiveness and safety of switching from one biological agent to another.
We aimed to evaluate the effectiveness and safety of etanercept as a sequential treatment in patients previously treated with efalizumab, and to evaluate different transition strategies from efalizumab to etanercept.
We present a retrospective study in patients with high-need plaque psoriasis who were unable to continue efalizumab and were immediately switched to etanercept.
We included 35 patients during a 4.5-year period. At 24 weeks of etanercept therapy, 57% of patients had a PASI reduction of 75%, suggesting that alternating between biological agents is feasible. We used three different switching approaches: (i) etanercept in combination with cyclosporine as bridge therapy, (ii) etanercept in combination with methotrexate as bridge therapy, (iii) etanercept monotherapy. Combination therapy was efficacious in all patients, including eight patients with rebound phenomenon with efalizumab. Etanercept was discontinued in two patients as a result of serious adverse events that consisted of an oral squamous cell carcinoma and a diffuse B-cell-non-Hodgkin lymphoma.
In our experience, it seems that etanercept alone may not be sufficient when transitioning from efalizumab in high-need patients with severe worsening or rebound of psoriasis. In such patients, combination of etanercept with cyclosporine or methotrexate is a more effective approach. Non-response to efalizumab did not preclude clinical response after switching to etanercept.
当传统治疗方法失败时，使用生物制剂已被证明是治疗银屑病的有效方法。然而，关于从一种生物制剂转换到另一种生物制剂的有效性和安全性的数据有限。
我们旨在评估依那西普作为序贯治疗在先前接受依法利珠单抗治疗的患者中的有效性和安全性，并评估从依法利珠单抗转换到依那西普的不同转换策略。
我们进行了一项回顾性研究，纳入了 4.5 年内无法继续接受依法利珠单抗治疗且立即转换为依那西普的高需求斑块状银屑病患者。
我们纳入了 35 例患者。在接受依那西普治疗 24 周时，57%的患者 PASI 降低 75%，表明交替使用生物制剂是可行的。我们使用了三种不同的转换方法：（i）依那西普联合环孢素作为桥接治疗，（ii）依那西普联合甲氨蝶呤作为桥接治疗，（iii）依那西普单药治疗。联合治疗在所有患者中均有效，包括 8 例出现依法利珠单抗反弹现象的患者。由于两名患者出现严重不良反应（包括口腔鳞状细胞癌和弥漫性 B 细胞非霍奇金淋巴瘤）而停用了依那西普。
根据我们的经验，在高需求、严重恶化或银屑病反弹的患者中，从依法利珠单抗转换为依那西普时，单独使用依那西普可能不够有效。在这些患者中，依那西普联合环孢素或甲氨蝶呤是更有效的方法。对依法利珠单抗无反应并不排除转换为依那西普后的临床反应。
