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Giornale Italiano di Dermatologia e Venereologia 2019 August;154(4):392-9

DOI: 10.23736/S0392-0488.18.06156-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

A multicenter retrospective case-control study on Suspension of TNF-inhibitors and Outcomes in Psoriatic patients (STOP study)

Giuseppe STINCO 1 , Nicola BALATO 2, Cinzia BULIGAN 1, Anna CAMPANATI 3, Stefano DASTOLI 4, Nicola DI MEO 5, Paolo GISONDI 6, Francesco LACARUBBA 7, Maria L. MUSUMECI 7, Maddalena NAPOLITANO 2, Annamaria OFFIDANI 3, Leonardo PESCITELLI 8, Stefano PIASERICO 9, Angelo PICCIRILLO 10, Francesca PRIGNANO 8, Enzo ERRICHETTI 1

1 Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy; 2 Unit of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy; 3 Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy; 4 Department of Health Sciences, Institute of Dermatology, University Magna Graecia, Catanzaro, Italy; 5 Department of Dermatology, University of Trieste, Trieste, Italy; 6 Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy; 7 Dermatology Clinic, University of Catania, Catania, Italy; 8 Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; 9 Unit of Dermatology, Department of Medicine, University of Padua, Padua, Italy; 10 Department of Dermatology, San Carlo Hospital, Potenza, Italy



BACKGROUND: There is limited information on patients undergoing withdrawal after long-term treatment with anti-TNF alpha drugs and their clinical evolution during the post-interruption period in real-life settings. The purpose of the present retrospective case-control study was to provide a clearer insight into the clinical management of psoriatic patients with adequate response to long-term adalimumab, etanercept and infliximab treatment once these biologic agents are interrupted.
METHODS: A total of 270 patients undergoing anti-TNF alpha agents discontinuation and 253 controls treated with a continuous regimen were enrolled. The primary endpoint was the change in disease activity in each study group over six months (or until treatment of psoriatic recurrence) as measured by the PASI score every month. Then, we evaluated the rate of and time to relapse, the rate of clinical worsening (PASI≥5) and the clinical variables influencing the loss of response.
RESULTS: Our study showed that about 50% of patients achieving a long-term and optimal response to the aforementioned anti-TNF alpha agents did not experience any relapse over a 6-month follow-up period after withdrawal. We also observed that subjects displaying a complete remission (PASI=0) at anti-TNF alpha therapy withdrawal experienced less frequently disease worsening and/or relapse compared to subjects having a PASI>0.
CONCLUSIONS: Our findings confirmed that all three anti-TNF alpha agents tend to retain their effectiveness upon re-administration in case of recurrence, even if they have been previously used for long time.


KEY WORDS: Psoriasis; Adalimumab; Etanercept; Infliximab; Biological therapy

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