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Therapy for Pediatric Psoriasis Gets a Shot in the Arm

Although several biologic agents have received FDA approval for treating psoriasis in adults, none have been evaluated for pediatric patients. To evaluate the safety and efficacy of the TNF inhibitor etanercept in children and adolescents with moderate-to-severe psoriasis, investigators performed a 42-site, double-blind, placebo-controlled trial in 211 patients (age range, 4–17 years; mean PASI score, 16.4). Half the patients received a weekly subcutaneous injection of etanercept (0.8 mg/kg to a maximum of 50 mg/week), and the other half received a placebo injection. After 12 weeks of treatment, 57% of the etanercept group but only 11% of the placebo group had improved by at least 75% (PASI, 75). All but six etanercept recipients continued treatment for another 24 weeks. At the end of 36 weeks, 69% of the etanercept group had at least 75% improvement, indicating that response could be maintained with continued treatment. Evaluation with the Physician Global Assessment and the Children’s Dermatology Life Quality Index also demonstrated encouraging responses with etanercept. The treatment was generally well tolerated, and when comparisons could be made, the frequency and severity of adverse events and serious adverse events were similar in the etanercept and placebo groups.

Comment: Studies have shown that psoriasis can have devastating emotional effects in younger patients. Unfortunately, no currently approved drugs are effective for moderate-to-severe psoriasis in children and adolescents. Etanercept has been used successfully with an acceptable safety profile for several years in children with juvenile rheumatoid arthritis. Also, published case reports show other biologics have been usefully employed in young patients: infliximab and adalimumab, particularly in pediatric inflammatory bowel disease, and efalizumab in atopic dermatitis. The results of this study provide hope that the deficit in pediatric psoriasis therapy will be remedied soon. Many of the medical and psychological problems associated with psoriasis, such as obesity, excessive alcohol intake, and smoking, are not yet apparent or severe in younger patients. With early treatment, averting or ameliorating them may be possible.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology January 16, 2008

Citation(s):

Paller AS et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med 2008 Jan 17; 358:241.

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