Humira effective for hand and foot psoriasis | Arthritis Information

MedWire News: Adalimumab is an effective and well tolerated treatment for chronic plaque psoriasis of the hands and feet, report researchers who found efficacy was maintained for at least 28 weeks.

Current treatment of hand and foot psoriasis is "unsatisfactory," say Craig Leonardi, from Central Dermatology in St Louis, Missouri, USA, and colleagues, because topical therapies and/or phototherapy are sometimes ineffective and inconvenient and some systemic therapies are limited by potential toxic effects.

They investigated the efficacy of the tumor necrosis factor inhibitor adalimumab in 72 patients with chronic plaque psoriasis on the hands and/or feet.

The participants were randomly assigned to receive adalimumab (initial dose of two 40-mg subcutaneous injections followed by 40 mg subcutaneously every other week) or placebo for 16 weeks followed by an open label 12-week extension, during which all patients received adalimumab.

At baseline, all the patients had moderate or severe scores on the Physician's Global Assessment of hands and/or feet (hfPGA) scale.

But by week 16, 15 (31%) of the 49 patients receiving adalimumab had achieved an hfPGA score of clear or almost clear, compared with just one (4%) of the 23 patients receiving placebo.

The researchers report in the Archives of Dermatology that the response to adalimumab was maintained, with 80% of patients with hfPGA scores of clear or almost clear at week 16 showing the same score at week 28. This included 12 of the 15 patients treated with adalimumab at the start of the study.

Patients treated with adalimumab also showed a rapid response to treatment, with 43% of patients achieving clear, almost clear, or mild hfPGA scores at week 4, compared with 13% of placebo-treated patients.

Adverse events experienced by patients were generally mild to moderate, with nasopharyngitis the most commonly reported (27% and 13% of adalimumab- and placebo-treated patients, respectively), and the incidence of symptomatic psoriasis flare was low.

The researchers conclude: "Despite the relatively small body surface area affected, patients with psoriasis of the hands and/or feet may experience substantial impairment in quality of life, including a high level of pain associated with the disease and a reduced ability to perform simple daily tasks.

"This study is among the first of its kind to analyze this subset and to demonstrate that adalimumab is a useful agent for treatment of moderate to severe chronic plaque psoriasis of the hands and/or feet."