The effectiveness and safety of adalimumab in the treatment of non-reimbursed patients with mild-to-moderate psoriasis.

Background Few reports exist on the use of biologics for treating patients with mild-to-moderate psoriasis, especially for non-reimbursed patients. Objectives This study aimed to evaluate the safety and effectiveness of adalimumab in non-reimbursed patients with mild-to-moderate psoriasis. Methods Fifty one patients with mild-to-moderate psoriasis treated with adalimumab 40 mg every other week (eow) in a tertiary referral hospital in Taiwan between 2007 and 2010 were retrospectively reviewed. The clinical effectiveness of adalimumab was assessed using Subjects Global assessment (SGA) and Physicians Global Assessment (PGA), and the reasons for discontinuation were evaluated. Results After 12 weeks of adalimumab (40 mg subcutaneously eow without a loading dose) treatment, 66% and 74% of patients had SGA and PGA scores of at least marked improvement (greater than 50% improvement compared with baseline psoriasis), respectively, with 60% and 53% of patients achieving SGA and PGA scores of at least marked improvement after 24 weeks. Ten (71%) of 14 previous non-responders to etanercept achieved a SGA or PGA score of at least marked improvement after adalimumab treatment. Adalimumab was generally well tolerated, but four patients (7.8%) discontinued adalimumab due to adverse events. The mean time required for resumption of systemic anti-psoriatic therapy was 6 months (range, 112 months). Apart from financial limitations, the most common reasons for discontinuation were primary (23.5%) and secondary (13.7%) lack of efficacy. Conclusion In non-reimbursed mild-to-moderate psoriasis patients, SGA and PGA remained high for adalimumab. Effectiveness and remission duration were key factors affecting patients willingness to pay for prolonged adalimumab treatment.