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Meetings/Links : Meeting Reports : Highlights
Highlights From a Meeting Held
July 20-24, 2005, in Chicago, Illinois

Editor
Richard Langley, MD, FRCPC
Assistant Professor of Medicine
Director of Research, Division of Dermatology
Dalhousie University
Halifax, Nova Scotia

Meeting Overview
There were a number of plenary sessions, corporate-sponsored symposia, and posters presented at this meeting in which the use of biologics in psoriasis was discussed. We will focus on a review of new data presented at this meeting and will not discuss any data presented previously.

T-Cell Agents
Alefacept: A fusion protein that prevents the activation of T cells by antigen-presenting cells and causes the depletion of memory T cells. For meeting highlights, click HERE.
Efalizumab: A humanized monoclonal antibody that blocks T-cell activation, reactivation, and trafficking into the skin. For meeting highlights, click HERE.
TNF Antagonists
Etanercept: A fusion protein that binds both TNF-a and TNF-b. For meeting highlights, click HERE.
Infliximab: A chimeric (murine/human) monoclonal antibody that binds TNF-a. For meeting highlights, click HERE.
Adalimumab: A human monoclonal antibody that binds TNF-a. For meeting highlights, click HERE.

T-Cell Agents
Alefacept

Alefacept Highlights
  • Safety and efficacy of an additional course of IM alefacept in patients weighing
    100 to 150 kg (Tan et al)1
  • High-dose (30 mg/wk) alefacept in patients with chronic plaque psoriasis (Feldman et al)2
  • Treatment of nail psoriasis (Parrish et al)3 and palmoplantar psoriasis
    (Pearce et al)4 with alefacept
  • Safety and efficacy of alefacept in combination with UVB light and other psoriasis therapies (Bagel)5
  • Safety and efficacy of alefacept in combination with methotrexate in the treatment of psoriatic arthritis (Lebwohl and Menter)6

The safety and efficacy of an additional course of intramuscular (IM) alefacept in patients weighing 100 to 150 kg was discussed by Tan et al.1 This open-label extension study was initiated at a single site, with seven patients evaluated. The median interval between the last dose in the randomized study and the first dose in this extension study was 47 weeks. The mean percentage improvement in Psoriasis Area and Severity Index (PASI) from baseline to the end of the trial was 25% in the randomized study versus 41% in the extension study. PASI 75 was achieved in 1 of 8 patients in the randomized study and in 1 of 7 patients in the extension study (Table 1).



Feldman et al2 evaluated the use of high-dose (30 mg/wk) alefacept in patients with chronic plaque psoriasis. In this open-label study, patients received an initial dose of alefacept 15 mg IM followed by alefacept 30 mg IM for 15 weeks, and were then followed for an additional 12 weeks. Eight patients have completed 16 weeks of therapy to date and have entered the follow-up period. This interim analysis up to week 16 demonstrated that a PASI 75 was achieved by 1 patient (12%), although the primary efficacy end point of 20 weeks had not yet been reached. Two patients had alefacept doses held for a low CD4+ count, although no serious adverse events or serious infections were reported.

Fifteen cases of nail psoriasis treated with alefacept were presented at this meeting by Parrish et al.3 All patients received alefacept 15 mg IM weekly for 12 weeks followed by 12 weeks of observation and were allowed concomitant topical therapy and phototherapy. The primary efficacy end point was a 50% improvement from baseline in target Nail Psoriasis Severity Index (NAPSI) score and a decrease of ≥1 point from baseline on the Physician's Global Assessment (PGA) at week 24. At week 24, NAPSI scores decreased to a median of 11 (range 2 to 25) and 5 of 15 patients (33%) had a ≥50% improvement in target NAPSI score.

An open-label study of alefacept for the treatment of palmoplantar psoriasis was presented by Pearce et al.4 Two study sites were involved, with a total of 15 patients enrolled. To date, 11 patients have completed the study. Subjects were allowed methotrexate or acitretin if they had been on a stable dose for at least 3 months prior to the study and could remain at this dose throughout the study. Alefacept was given at 15 mg IM weekly for 16 weeks. After 8 weeks, dose escalation was allowed to 30 mg weekly for the remainder of the study. Patients were then observed for an additional 12 weeks. The primary end points were the Palmoplantar Psoriasis Severity Instrument (PPSI) and the PGA score of palmoplantar psoriasis. Mean improvement was 18% at one site and 45% at the other site. PGA scores followed similar trends.

Bagel5 evaluated the safety and efficacy of multiple courses of alefacept in combination with ultraviolet B (UVB) light and other psoriasis therapies. Alefacept 15 mg IM was given weekly for 12 weeks followed by 12 weeks of observation, with patients allowed one concomitant therapy (either narrowband or broadband UVB 2 to 3 times per week, cyclosporine, methotrexate, prednisone, systemic retinoids, or topical therapy). Patients were eligible for retreatment if they had received at least 8 doses of alefacept and completed the follow-up visits. At the time of this analysis, 386 patients had completed the clinic visit 12 weeks after receiving the last dose of the first course of alefacept. Of these, 23% received alefacept plus UVB. The combination of alefacept with UVB improved PGA scores by ≥2 categories in 76% of patients and by ≥1 category in 88% of patients. The adverse event profile was similar to that seen with alefacept alone.

The results of a study of the safety and efficacy of alefacept in combination with methotrexate in the treatment of psoriatic arthritis were reported by Lebwohl and Menter.6 A total of 185 patients on methotrexate were randomized to receive alefacept 15 mg IM or placebo for 12 weeks. One hundred and nineteen patients completed 12 weeks of alefacept plus methotrexate. At week 24, of the patients treated with alefacept plus methotrexate, 54% achieved ACR 20 and 22% achieved PASI 75, versus 23% and 10%, respectively, in the patients treated with placebo plus methotrexate. Adverse events were similar in the two groups, and no new adverse events occurred due to the combination therapy.

Efalizumab

Efalizumab Highlights
  • The successful treatment of pustular palmoplantar psoriasis (Jones and Urban),7 scalp psoriasis (Kircik),8 and refractory erythrodermic psoriasis (Sluzevich)9 with efalizumab
  • Patient-reported outcomes with efalizumab treatment in patients on concurrent topical or phototherapy or recently transitioned from nonbiologic systemic therapy (Fivenson et al)11
  • Safety and efficacy of efalizumab in combination with methotrexate (Papp et al)12 and in patients with high body weight (Lebwohl et al)13

Jones and Urban7 presented a case report involving the treatment of pustular palmoplantar psoriasis with efalizumab. The patient was a Caucasian female 50 years of age whose psoriasis was refractory to topical steroids (clobetasol, halobetasol), antibiotics (cephalexin), and oral acitretin (25 mg per day). The patient was started on therapy with subcutaneous efalizumab 1 mg/kg/wk, and her psoriasis began to respond within the first month of treatment. The patient has continued to receive efalizumab therapy, and her psoriasis has remained controlled for at least 11 months to date.

A case report of a patient with scalp psoriasis treated with efalizumab was presented by Kircik.8 The patient was a 48-year-old woman with a 26-year history of scalp psoriasis. Previous therapies for her scalp psoriasis included topical and intralesional corticosteroids; antifungal, tar, and steroid shampoos; topical vitamin D derivative; and topical immunomodulatory therapy. The patient's scalp psoriasis did not respond well to any of these therapies. Efalizumab treatment was initiated in January 2004 (subcutaneous administration at a dose of 0.7 mg/kg initially, followed by 1 mg/kg/wk), with clobetasol lotion used concomitantly for the first month of efalizumab therapy and ciclopirox shampoo used concomitantly for the entire duration of efalizumab therapy. After 10 weeks, the patient had significant improvement in her scalp psoriasis. After 3 months of continuous efalizumab therapy, the patient's scalp psoriasis was rated "clear" by PGA scoring. During efalizumab treatment no adverse events or abnormal laboratory measurements occurred. In July 2004, efalizumab therapy was discontinued because of a change in the patient's insurance policy coverage. Three months after treatment discontinuation, the patient continued to use ciclopirox shampoo supplemented by once-monthly UVB phototherapy. Minimal recurrence of psoriasis had begun to appear on her ears, prompting initiation of topical tacrolimus and a medium-potency topical corticosteroid. The patient did not experience any rapid worsening of psoriasis (rebound) following efalizumab discontinuation.

Another case report was presented by Sluzevich9 and involved the successful treatment of refractory erythrodermic psoriasis with efalizumab in a high-need patient. High-need patients are defined as those for whom at least two currently available systemic psoriasis therapies have proven unsuitable due to lack of efficacy, intolerability, or contraindication.10 This patient was a 53-year-old female with a 15-year history of psoriasis and a 10-year history of mutilating psoriatic arthritis, with concomitant medical conditions that included osteoporosis, hypertension, dyslipidemia, and spastic colon. This patient had also been treated with multiple antipsoriasis medications, both nonbiologic and biologic, that had proven ineffective or intolerable, including cyclosporine (5 mg/kg/d) plus acitretin (up to 25 mg/d), methotrexate (10 mg/d), 6-thioguanine (40 to 60 mg/d), and infliximab (5 mg/kg). In addition, this patient developed methicillin-resistant Staphylococcus aureus sepsis after the second infusion, which was further complicated by acute endocarditis; consequently, all immunosuppressive agents were discontinued for 6 months. The patient was then started on etanercept 25 mg twice weekly. At this dose, the patient's erythroderma nearly cleared by 8 weeks of therapy, although residual disease remained on her lower extremities. After 3 months of treatment, the patient had a severe generalized inflammatory psoriatic flare characterized by unstable psoriasis, new plaques, and increasing erythroderma. The etanercept dosage was increased to 50 mg twice weekly, but the patient progressed to full-body erythroderma without improvement at the higher dose. Etanercept therapy was discontinued after 4.5 months of therapy. Efalizumab therapy (1 mg/kg/wk) was initiated following the discontinuation of etanercept, and after 6 weeks, the patient was nearly clear. After 4 months, the patient developed inframammary intertrigo. The condition was cleared after 1 week of concomitant oral fluconazole. After >1 year on continuous efalizumab therapy, the patient was completely free of psoriasis signs, with no other concomitant psoriasis treatments required. The patient also reported decreased pain and tenderness in her joints affected by psoriatic arthritis. The patient reported no other adverse events related to efalizumab therapy.

Fivenson et al11 evaluated the impact of efalizumab on patient-reported outcomes in an open-label study of psoriasis patients who were using concurrent topical or phototherapy or who had recently transitioned from nonbiologic systemic psoriasis therapies. Concomitant psoriasis therapies were allowed during the study at the investigator's discretion and included emollients, scalp preparations, topical preparations (including corticosteroids), psoralen plus ultraviolet A (PUVA) therapy, UVB (broadband or narrowband) phototherapy, and tanning beds, in addition to oral or topical antihistamines for pruritus. Patients were given subcutaneous efalizumab 1 mg/kg/wk. A total of 1036 patients with moderate to severe chronic plaque psoriasis were enrolled at 207 sites and received at least 1 dose of efalizumab. At baseline, patients had a median body surface area (BSA) affected by psoriasis of 26% (mean 32% ± 19%), with a median duration of psoriasis of 16 years (mean 17.5 ± 11.6 years). Patients rated the level of itch using a Visual Analog Scale (VAS) on the day of their study visit, with a score of 0 representing no itch and 10 representing severe itch. Patients reported their progress at day 0 (baseline, prior to treatment with efalizumab) and at weeks 1, 2, 6, and 12 of efalizumab treatment. Early improvement in degree of itch was observed within 7 days of efalizumab initiation, after a single conditioning dose. This represents the earliest assessment of itch in an efalizumab study. After 7 days, the mean improvement on the itch VAS (within-patient) was 1.0, reflecting a mean percentage of improvement from baseline of 13%. The safety profile of efalizumab was similar to that demonstrated in previous phase III clinical trials.

The safety of efalizumab administered in combination with concomitant methotrexate was evaluated by Papp et al12 in a multicenter phase II study of patients with psoriatic arthritis. The study consisted of a 12-week, randomized, double-blind, placebo-controlled phase (weeks 1 through 12) followed by a 12-week open-label extension treatment phase (weeks 13 through 24). Patients were required to be on preexisting stable doses of either nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, and/or a disease-modifying anti-rheumatic drug (DMARD) limited to either sulfasalazine or methotrexate. The analysis presented included only the methotrexate-using patient subgroup, as sulfasalazine is not considered a commonly used option for the treatment of psoriasis. A total of 107 patients entered the study, with 47 (44%) patients using methotrexate. Of these, 22 patients were randomized to receive efalizumab 1 mg/kg/wk during the initial treatment phase of the trial. Efalizumab was generally well tolerated by patients utilizing methotrexate concomitantly during the study, with the adverse event profile of efalizumab exposure for 12 or 24 weeks similar to that for placebo.

Lebwohl et al13 evaluated the efficacy and safety of subcutaneous (SC) efalizumab (1 mg/kg/wk) in high-body-weight patients (≥100 kg) with moderate to severe chronic plaque psoriasis. The safety analyses were based on summary data from 4 clinical studies and the efficacy analyses were based on summary data from 3 clinical studies (1 study was designed primarily as a safety study and was excluded). The incidence of adverse events and serious adverse events was low and comparable between weight groups and with that of placebo-treated patients, with no weight-related differences observed. Efficacy was assessed by the proportion of patients achieving PASI 50 and PASI 75. Clinical responses to efalizumab therapy were similar between the weight groups, with 29% of patients achieving PASI 75 in the <100-kg weight group and 25% of patients achieving PASI 75 in the ≥100-kg weight group (Figure 1), supporting the rationale for weight-based dosing of efalizumab.



TNF Antagonists
Etanercept

Etanercept Highlights
  • Use of etanercept in a pediatric psoriasis population (Siegfried at al)14
  • Effect of etanercept on psoriatic skin lesions in patients with a history of psoriatic arthritis (Lebwohl et al)15
  • Etanercept Assessment of Safety and Effectiveness (EASE) trial: analysis of the first 12 weeks (Gordon et al)16
  • Safety and efficacy of etanercept 50 mg twice weekly (Tyring et al)17
  • Open-label trial of etanercept in patients with psoriatic arthritis and psoriasis (Goffe et al)18

While no biologic agents are currently approved for pediatric psoriasis, there is an unmet need for a safe and effective treatment for moderate to severe psoriasis in children. Etanercept has been approved for use in juvenile rheumatoid arthritis patients aged 4 to 17, and therefore it is of interest to evaluate the use of etanercept in the pediatric psoriasis population. Siegfried et al14 presented the design of such a study, in which patients 4 to 17 years of age have been enrolled (with a mean age of 13.3 years). As of April 2005, 76 subjects had received at least one dose of etanercept in this ongoing study.

A retrospective analysis of two 12-week phase III trials was presented by Lebwohl et al15 that evaluated the effect of etanercept on psoriatic skin lesions in patients with a history of psoriatic arthritis compared to a group of patients who do not have psoriatic arthritis. Patients received either etanercept 25 mg twice weekly (BIW) or 50 mg BIW and were stratified as to the presence or absence of psoriatic arthritis or self-reported psoriatic arthritis. Body surface area, duration of psoriasis, and mean PASI at baseline were comparable between the groups. At week 12 PASI 75 was achieved by 37% of patients with psoriatic arthritis and 33% of patients without psoriatic arthritis for the 25-mg BIW group and 46% and 51%, respectively, in the 50-mg BIW group.

The Etanercept Assessment of Safety and Effectiveness (EASE) trial is a multicenter, open-label, prospective, phase IIIb study designed to compare the effectiveness of continuous versus intermittent etanercept therapy in patients with psoriasis in the community dermatology setting. It is planned to involve approximately 2500 patients at 350 centers in the US. The results from the first 12 weeks of this 24-week study, during which patients received etanercept 50 mg twice weekly, were described by Gordon et al.16 All measures of efficacy confirmed earlier findings with etanercept. Of particular interest was the finding that depression measured by the Beck Depression Inventory showed a marked improvement, with a decrease from 8.2 at baseline to 4.5 at week 12 (Figure 2). In addition, a Healthcare Resource Utilization Inventory was conducted, and it was determined that the number of days hospitalized in the past 3 months decreased by 33%, the mean number of ER or urgent care visits decreased by 37% in 3 months, and the mean visits to a non-dermatology physician's office also decreased by 37% (Figure 3).





Interim results of an ongoing 2-year safety and efficacy study of etanercept 50 mg twice daily were reported by Tyring et al.17 The design involved a 12-week, double-blind, placebo-controlled study, followed by an 84-week open-label extension study. Data were presented for 36 weeks of open-label extension for a total of up to 48 weeks of continuous therapy. PASI 75 was achieved by approximately 60% of patients by week 24 and has been maintained through 48 weeks of therapy.

In a large open-label multicenter study in patients with psoriatic arthritis and psoriasis, Goffe at al18 reported that there were no consistent predictors of response.

Infliximab

Infliximab Highlights
  • Express Study: safety and efficacy of infliximab 5 mg/kg at weeks 0, 2, 6, and then every 8 weeks (Reich et al)19
  • Safety and efficacy of infliximab 3 or 5 mg/kg at weeks 0, 2, 4, 6, and then every 8 weeks (Gottlieb et al)20

Results of the Express Study, a multicenter, randomized, placebo-controlled clinical trial using infliximab in psoriasis, were presented by Reich et al.19 Patients received infliximab 5 mg/kg at weeks 0, 2, 6, and then every 8 weeks up to week 46. Placebo was given to one group through week 22, after which they were crossed over at week 24 and received the same dose as the 5 mg/kg group, starting with weeks 0, 2, and 6 dosing. An intent-to-treat (ITT) analysis involving all the patients who entered the study was the prespecified analysis group. There were 301 patients entered into the trial, but by week 50 there were 281 patients in the analysis. The authors explained that if patients were nonresponders or if a significant prohibited medication was used concomitantly, they were excluded. The second analysis performed was a per-protocol analysis, in which patients were excluded if they missed 2 infusions or the data after the infusion were not available. Nonresponders or those who used significant prohibited medications concomitantly were also excluded. At both week 10 and 24, PASI 75 was 80% (77 in the placebo group and 301 in the infliximab group). In the prespecified ITT analysis, 281 patients were analyzed, with 234 patients in the per-protocol analysis. At 50 weeks, PASI 75 was achieved by 61% in the prespecified analysis group and 71% in the per-protocol analysis group; PASI 50 was achieved by 69% and 80%, respectively; and PASI 90 was achieved by 45% and 56%, respectively.

Gottlieb et al20 evaluated the use of infliximab every 8 weeks following initial dosing at weeks 0, 2, and 6 or as needed (PRN) at the physician's discretion or patient request after week 6. Dose groups were placebo (n=208), infliximab 3 mg/kg (n=313), and infliximab 5 mg/kg (n=314). After 10 weeks the placebo group received infliximab 5 mg/kg and the 3-mg/kg and 5-mg/kg groups continued at these doses. At week 10, PASI 50 was achieved by 86% and 93% of the 3-mg/kg and 5-mg/kg groups, respectively; PASI 75 was achieved by 70% and 76%, respectively; and PASI 90 was achieved by 37% and 45%, respectively. At week 26, PASI 75 was achieved by 65% of the 3-mg/kg every-8-weeks group (n=148); 78% of the 5-mg/kg every-8-weeks group (n=150); 42% of the PRN at 3-mg/kg group (n=148); and 58% of the PRN 5-mg/kg group (n=149). Infliximab was given for up to 30 weeks, and data were obtained at 26 weeks.

Adalimumab

Adalimumab Highlights
  • Safety and efficacy of adalimumab in patients with psoriatic arthritis (Mease at al21 and Kavanaugh et al22)

Two posters that described the effects of adalimumab on patients with psoriatic arthritis were presented. Mease et al21 evaluated whether adalimumab inhibited the radiographic progression of joint disease in patients with moderate to severe psoriatic arthritis. Patients were stratified by methotrexate use and degree of psoriasis and received either adalimumab 40 mg or placebo every other week for 24 weeks. Change in modified Total Sharp Score (mTSS) was evaluated at week 24. Twenty-one percent of placebo-treated patients had an increase in mTSS at week 24 compared to only 10% of adalimumab-treated patients. Also, statistically significant differences were observed between adalimumab-treated and placebo-treated patients for both erosion scores and joint space narrowing scores. These statistically significant differences occurred regardless of concomitant methotrexate use.

The second study was presented by Kavanaugh et al22 and was designed to compare the efficacy of adalimumab plus methotrexate versus adalimumab monotherapy in patients with moderate to severe psoriatic arthritis. Of 151 patients entered into the study, approximately 50% were on concomitant methotrexate. At baseline, patients with concomitant methotrexate had a shorter duration of psoriatic arthritis and a lower swollen joint count compared with those receiving adalimumab alone. For the adalimumab monotherapy group, 69% had previously been treated with DMARDs and 55% had previously received methotrexate. Of patients receiving adalimumab alone, 61% achieved an ACR 20 at week 12 and 59% at week 24. In comparison, of the patients receiving adalimumab plus methotrexate, 55% achieved an ACR 20 at both weeks 12 and 24 (Figure 4).



References
  1. Tan J, Yee LL, Zajner M, et al. Efficacy and safety of an additional course of intramuscular alefacept in patients weighing 100-150 kg. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  2. Feldman SR, McCarty MA, Pearce D, et al. Alefacept plus broadband UVB therapy for chronic plaque psoriasis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  3. Parrish C, Elewski BE, Robbins C, et al. The treatment of nail psoriasis with alefacept. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  4. Pearce D, Feldman S, Carroll C, et al. Open-label study of alefacept for the treatment of palmoplantar psoriasis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  5. Bagel J. Efficacy and safety of multiple courses of alefacept in combination with UVB light and other psoriasis therapies. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  6. Lebwohl M, Menter A. Efficacy and safety of alefacept in combination with methotrexate in the treatment of psoriatic arthritis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster.


  7. Jones L, Urban CD. Treatment of palmoplantar pustular psoriasis with efalizumab. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 119.


  8. Kircik L. Treatment of scalp psoriasis with efalizumab. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 120.


  9. Sluzevich JC. Successful treatment of refractory erythrodermic psoriasis with efalizumab in a high-need patient. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 121.


  10. Papp KA, Langley RGB, Shear NH, et al. Efficacy and safety of efalizumab therapy in high-need psoriasis patients. Presented at: 63rd Annual Meeting of the American Academy of Dermatology; February 18-22, 2005; New Orleans, La. Poster 2746.


  11. Fivenson D, Turner J, Caro I, et al. Impact of efalizumab on patient-reported outcomes: a phase IIIb open-label study of psoriasis patients who may have used concurrent topical or phototherapy or who may have recently transitioned from nonbiologic systemic psoriasis therapies. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 118.


  12. Papp KA, Caro I, Garovoy M, et al. The safety of efalizumab administered in combination with concomitant methotrexate. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 122.


  13. Lebwohl M, Rafal ES, Caro I, et al. Efficacy and safety of efalizumab in patients with high body weight: pooled results from randomized phase III trials. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 123.


  14. Siegfried EC, Levy ML, Jahreis A, et al. Etanercept in children and adolescents with psoriasis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P81.


  15. Lebwohl M, Powers J, Gordon KB, et al. Evaluation of PASI responses to etanercept therapy in psoriasis patients with or without psoriatic arthritis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P93.


  16. Gordon KB, Kang S, Kimball A, et al. Etanercept in patients with psoriasis: analysis of the first 12 weeks of the Etanercept Assessment of Safety and Effectiveness (EASE) trial. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P97.


  17. Tyring S, Poulin Y, Langley R, et al. A 2-year phase 3 study of safety and efficacy of etanercept 50 mg twice weekly in patients with psoriasis: 48-week results. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P134.


  18. Goffe B, Mowad C, Eisen D, et al. No consistent predictors of skin or joint responses observed in EDUCATE: a large open-label, multicenter study in patients with psoriatic arthritis receiving etanercept. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P135.


  19. Reich K, Nestle F, Ortonne J-P, et al. Maintenance of significant improvement in psoriasis over 50 weeks of continuous therapy with infliximab. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P130.


  20. Gottlieb A, Feldman S, Weinstein G. Infliximab phase III results: every 8 weeks versus as needed maintenance therapy. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P131.


  21. Mease PJ, Gladman DD, Ritchlin CT, et al. Adalimumab inhibits radiographic disease progression in patients with psoriatic arthritis. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster P95.


  22. Kavanaugh A, Antoni C, Beutler A, et al. Association between improvement in enthesopathy and quality of life: results from the IMPACT 2 trial. Presented at: Summer Academy 2005 of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill. Poster 124.