Combining etanercept, methotrexate improves psoriasis in psoriatic arthritis
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Etanercept monotherapy or a combination of etanercept and methotrexate had better psoriasis outcomes than methotrexate alone, according to a poster presented at the American Academy of Dermatology virtual meeting.
A multicenter, double-blind, randomized, controlled phase 3 trial evaluated 851 patients with psoriatic arthritis who were treatment-naive to biologics and had no previous methotrexate use.
Three treatment arts were identified: methotrexate 20 mg weekly, etanercept 50 mg weekly and a weekly combination of both drugs.
After 24 weeks of treatment, of those with baseline body surface area (BSA) of 3% or greater, 68.7% of those treated with etanercept alone reached BSA of 3% or less, while 74.2% in the combination group reached this level (P = .01). Of those in the methotrexate monotherapy group, 61.5% achieved BSA of 3% or less.
BSA of 1% or less was reached by 57.1% in the combination group (P = .022), 49.4% in the etanercept group and 44.7% in the methotrexate group.
Static Physician’s Global Assessment (sPGA) × BSA of 3 or less was achieved by 71.4% of those in the combination group (P = .007) compared with 63.3% and 57.3% of patients in the etanercept and methotrexate groups, respectively.
sPGA × BSA of 1 or less was achieved in 58.4% in the combination arm (P = .004), 45.8% in the etanercept arm and 42.7% in the methotrexate arm.
For those with BSA of 10% or greater at baseline, 64% in the combination group (P = .003) achieved BSA of 3% or less compared with 58.2% in the etanercept group and 42.4% in the methotrexate group. BSA of 1% or less was reached by 47.7% of the combination group (P = .027), 44% of the etanercept group and 31.5% of the methotrexate group.
The combination group also had 64.7% of patients (P < .001) showing sPGA × BSA of 3 or less compared with 56% of etanercept-treated patients and 39.6% of methotrexate-treated patients. sPGA × BSA of 1 or less was reached 49.4% of the combination group (P = .008), 44% of the etanercept group (P = .012) and 29.7% of the methotrexate group.
According to the study authors, etanercept monotherapy “had numerically greater psoriasis outcome results” than methotrexate monotherapy. The addition of methotrexate “numerically improved” etanercept on skin endpoints.
Adverse events during the study included nausea through week 48 in 13.1% of subjects in the methotrexate group, 6.4% of subjects in the etanercept group and 14.4% of subjects in the combination group.
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Merola JF, et al. Psoriasis outcomes in a randomized trial of etanercept and methotrexate as monotherapy or in combination in patients with psoriatic arthritis. Presented at: AAD VMX; June 12-14, 2020 (virtual meeting).
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