A Retrospective Study to Investigate Racial and Ethnic Variations in the Treatment of Psoriasis With Etanercept

August 2011 | Volume 10 | Issue 8 | Original Article | 866 | Copyright © 2011

Abstract

Objectives: Psoriasis is a chronic inflammatory condition that occurs worldwide; however, few studies have examined this condition in non-Caucasian populations. The purpose of this study was to investigate racial/ethnic differences in demographics, psoriasis severity, efficacy, safety, and health-related quality of life in patients treated with etanercept using data from the Etanercept Assessment of Safety and Effectiveness (EASE) in Psoriasis trial.
Patients and Methods: This is an investigator-initiated evaluation of data from the EASE study.
Results:The study included 2511 patients (Caucasian n=2164; Hispanic/Latino n=173; African American n=98; Asian n=76). Although baseline Physicians' Global Assessment (PGA) scores were similar, we found significant baseline differences in patient characteristics, prior therapy, percentage of body surface area (%BSA) affected and Dermatology Life Quality Index (DLQI) scores between the groups. At baseline, the Caucasian group had the longest disease duration (19 years), but the lowest percentage of BSA involvement (28%). The Asian group had the highest percentage of BSA involvement (41%). Baseline DLQI score was lowest for Caucasians (12.0) and highest for Hispanic/Latinos (14.6).
At week 12, response to therapy was similar in all ethnic/racial groups. The BSA involvement was reduced by more than 50 percent for all groups, but remained significantly higher for the Asian group (17%) than for the Caucasian (13%; P=0.0105) and African American groups (13%; P=0.0461).
At week 12, the mean Asian DLQI score of 5.2 was significantly higher (worse) than scores for the Caucasian (3.5; P=0.0001) and Hispanic/Latino groups (3.8; P=0.028). For both percentage of BSA and DLQI, differences among racial/ethnic groups in the percentage improvement from baseline were not statistically significant. Adverse event rates were similar for the groups.
Conclusions:Patient characteristics at enrollment differed among ethnic groups, but no significant racial/ethnic differences were found in safety or efficacy of etanercept. However, racial/ethnic differences in the impact of psoriasis on quality of life were observed.

J Drugs Dermatol. 2011;10(8):862-868.

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INTRODUCTION

Psoriasis is a chronic, immune-mediated, inflammatory condition that occurs worldwide; frequency varies greatly among different racial and ethnic groups.1,2 The prevalence of psoriasis has been estimated at 1.3 percent in African Americans, 2.5 percent in Caucasians, 0.8 percent in Hispanics, 0.3 percent in Asians, and 2 -3 percent in the overall U.S. population.1,3-7 Treatments for psoriasis include topical and oral agents and phototherapy. Systemic biologic therapies such as etanercept, infliximab and adalimumab have been used in patients with moderate-to-severe psoriasis.

Several studies have documented the impact of psoriasis on quality of life,6,8,9 but few studies have investigated the burden of psoriasis in non-Caucasian populations. Likewise, published studies rarely report racial and ethnic variations in disease presentation, severity, clinical course, and response to treatment. The purpose of this study was to investigate racial/ethnic differences in demographics, psoriasis severity, efficacy, safety and health-related quality of life (HRQoL) in patients who received treatment with etanercept for moderate to severe plaque psoriasis, using data from the Phase 3b/4 Etanercept Assessment of Safety and Effectiveness (EASE) in Psoriasis trial.10

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