Changes in C-reactive protein in patients with moderate-to-severe psoriasis switched to adalimumab therapy after suboptimal response to etanercept, methotrexate or phototherapy.

ABSTRACT

BACKGROUND: Psoriasis treatment can lower levels of the inflammatory biomarker C-reactive protein (CRP). OBJECTIVE: Evaluate CRP changes in patients with chronic plaque psoriasis who switched to adalimumab following suboptimal response to previous therapies. METHODS: C-reactive protein was measured at screening and after 16 weeks of adalimumab treatment following discontinuation of previous therapies etanercept (substudy E; n = 77), methotrexate (substudy M; n = 38) or narrow-band ultraviolet B phototherapy (substudy P; n = 27). Associations of CRP with baseline characteristics and efficacy measures were evaluated. RESULTS: Median CRP change at the final visit was -0.3 mg/L overall and -0.4, -0.3 and -0.3 mg/L in substudies E, M and P respectively. Clinical response [Physician Global Assessment (PGA) 'clear' or 'minimal'] was associated with greater CRP reductions vs. no response (PGA 'mild' or worse) overall (-0.4 vs. -0.3 mg/L) and in substudies E (-0.4 vs. -0.1 mg/L) and M (-0.5 vs. -0.2 mg/L), but not P (-0.1 vs. -0.4 mg/L). CRP decreases were, respectively, -0.4 and -0.3 mg/L in patients with and without a history of psoriatic arthritis and -0.1, -0.3 and -0.6 mg/L in normal weight, overweight and obese patients, respectively. CRP decreases after 16 weeks correlated positively (ß = 0.004) with percentage change in Psoriasis Area and Severity Index (PASI; P = 0.0398) and negatively (ß = -0.360) with baseline CRP (P < 0.0001). CONCLUSION: C-reactive protein levels decreased during adalimumab therapy in patients with psoriasis who experienced suboptimal response to previous therapies. Clinical response was associated with greater CRP reductions overall and in substudies E and M, but not P. CRP reductions correlated with percentage reductions in PASI.