Considerazioni sui farmaci biologici nel trattamento della psoriasi a placche e loro impatto economico. Focus su etanercept


Parole chiave

anti-TNF-α budget impact costo psoriasi a placche terapie biologiche 


Plaque psoriasis is a common inflammatory skin condition with a significant impact on quality of life and social costs. The prevalence of psoriasis is about 2–3%. Recent developments in systemic targeted therapies, like biological agents (anti-T-cell agents and inhibitors of tumour-necrosis-factor-α), have offered an alternative treatment approach which may translate into disease control and improvement of quality of life. The British Association of Dermatologists Guidelines (2005) stated that etanercept should be considered the first choice for patients with significant and stable psoriasis. A Consensus Paper of Italian Dermatologists has recently stated (2008) that, according to the ‘physiologic’ paradigm of selection among TNF-antagonists linked to more or less physiologic mechanisms of action, etanercept appears to be the anti-TNF of choice for treating most patients with moderate to severe plaque psoriasis and psoriatic arthritis, possibly even at an early stage. Etanercept, unlike other biological agents, is approved for the intermittent treatment (up to 24 weeks) of the psoriasis in Europe. Overall, the biological agents showed high efficacy in the treatment of patients who have not responded to other systemic therapies. No head-to-head studies comparing those agents are available in the peer-reviewed literature, but the economic impact showed higher cost of other biological agents compared to intermittent etanercept in the treatment of psoriasis. It would seem reasonable to state that intermittent therapy with etanercept results in a more contained budget impact in comparison to the other suitable biological agents for the treatment of psoriasis.

Taking for granted the general recognition of innovation of the new biological therapies, the debate is now focused on the sustainability of the expense for these therapies by National Health Services. Considering this need, the saving opportunity offered by an intermittent biological therapy seems to be remarkable.


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  1. 1.
    Koo J. Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14: 485–96PubMedCrossRefGoogle Scholar
  2. 2.
    Lebwohl M. Psoriasis. Lancet 2003; 361: 1197–204PubMedCrossRefGoogle Scholar
  3. 3.
    Williams HC. Dermatology. In: Stevens A, Raftery J (eds). Health care needs assessment: the epidemiologically based needs assessment reviews: second series. Oxford: Radcliffe Medical Press, 1997Google Scholar
  4. 4.
    Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) — a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–6PubMedCrossRefGoogle Scholar
  5. 5.
    Rapp SR, Cottrell CA, Leary MR. Social coping strategies associated with quality of life decrements among psoriasis patients. Br J Dermatol 2001; 145: 610–6PubMedCrossRefGoogle Scholar
  6. 6.
    Finlay AY, Henley LA. Quality of life and cost-effectiveness of treatment. J Dermatolog Treat 1997; 8: 28–9CrossRefGoogle Scholar
  7. 7.
    Schön MP, Boehncke WH. Psoriasis. N Engl J Med 2005; 352: 1899–912PubMedCrossRefGoogle Scholar
  8. 8.
    Sato R, Piercy J, Kay S, et al. Higher psoriasis disease severity is associated with increased comorbidities in Europe. Poster presented at the Autumn Meeting of the European Academy of Dermatology and Venereology, Rhodes, Greece, 2006Google Scholar
  9. 9.
    Naldi L, Colombo P, Placchesi EB, et al. Study design and preliminary results from the pilot phase of the PraKtis Study: self reported diagnoses of selected skin diseases in a representative sample of the Italian population. Dermatology 2004; 208: 38–42PubMedCrossRefGoogle Scholar
  10. 10.
    Saraceno R, Mannheimer R, Chimenti S. Regional distribution of psoriasis in Italy. J Eur Acad Dermatol Venereol 2008; 22: 324–9PubMedCrossRefGoogle Scholar
  11. 11.
    Poikolainen K, Karvonen J, Pukkala E. Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999; 135: 1490–3PubMedCrossRefGoogle Scholar
  12. 12.
    Colombo G, Altomare G, Peris K, et al. Moderate and severe plaque psoriasis: cost-of-illness study in Italy. Ther Clin Risk Manag 2008; 4: 559–68PubMedGoogle Scholar
  13. 13.
    Horn L. National Psoriasis Foundation survey data. Oral presentation at the American Academy of Dermatology. Washington, DC, Oct 30, 2006Google Scholar
  14. 14.
    Enbrel. Riassunto delle caratteristiche del prodottoGoogle Scholar
  15. 15.
    Smith CH, Anstey AV, Barker JN, et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 2005; 153: 486–97PubMedCrossRefGoogle Scholar
  16. 16.
    Altomare G, Ayala F, Berardesca E, et al. Etanercept provides a more physiological approach in the treatment of psoriasis. Dermatologic Therapy 2008; 21(2): S1–S14PubMedCrossRefGoogle Scholar
  17. 17.
    van de Kerkhof PCM, Segaert S, Lahfa M, et al. Once weekly administration of etanercept 50 mg is efficacious and well tolerated in patients with moderate-to-severe plaque psoriasis: a randomized controlled trial with open-label extension. Br J Dermatol 2008; 159: 1177–85PubMedGoogle Scholar
  18. 18.
    Carey W, Glazer S, Gottlieb AB, et al. Relapse, rebound, and psoriasis adverse events: an advisory group report. J Am Acad Dermatol 2006; 54 (4 Suppl. 1): S171–81PubMedCrossRefGoogle Scholar
  19. 19.
    Gordon KB, Gottlieb AB, Leonardi CL, et al. Clinical response in psoriasis patients discontinued from and then reinitiated on etanercept therapy. J Dermatolog Treat 2006; 17: 9–17PubMedCrossRefGoogle Scholar
  20. 20.
    Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2007; 56: 31.e1–31.e15.CrossRefGoogle Scholar
  21. 21.
    Remicade. Riassunto delle caratteristiche del prodottoGoogle Scholar
  22. 22.
    Bartelds GM, Wilbrandts CA, Nurmohamed NT, et al. Clinical response to adalimumab: relationship to anti-adalimumab antibodies and serum adalimumab concentrations in rheumatoid arthritis. Ann Rheum Dis 2007: 66: 921–6PubMedCrossRefGoogle Scholar
  23. 23.
    Humira. Riassunto delle caratteristiche del prodottoGoogle Scholar
  24. 24.
    Papp K, Poulin Y, Bissonnette R, et al. Assessment of the long-term safety of etanercept for the treatment of psoriasis in an adult Canadian population. Poster presented at EADV Fall 2008Google Scholar
  25. 25.
    National Institute for Clinical Excellence (NICE). Etanercept and efalizumab for the treatment of adults with psoriasis. Technology Appraisal Guidance n. 103, July 2006Google Scholar
  26. 26.
    National Institute for Clinical Excellence (NICE). Infliximab for the treatment of adults with psoriasis. Technology Appraisal Guidance n. 134, January 2008Google Scholar
  27. 27.
    Heinen-Kammerer T, Daniel D, et al. Cost-effectiveness of psoriasis therapy with etanercept in Germany. J Dtsch Dermatol Ges. 2007; 5: 762–8PubMedCrossRefGoogle Scholar
  28. 28.
    Chiou CF. Cost-efficacy comparison of biologics in the treatment of psoriasis. Presented at 62th Annual Meeting of the American Academy of Dermatology. Washington, DC, February 2004Google Scholar
  29. 29.
    Lloyd A, Reeves P, Conway P, et al. Economic evaluation of etanercept in the management of chronic plaque psoriasis. Br J Dermatol 2008 Sep 19. [Epub ahead of print]Google Scholar
  30. 30.
    Martini P, Mazzatenta C, Grazzini M. I costi delle terapie biologiche. Psoriasis 2007; 2: 36–9Google Scholar

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© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.Centro di Ricerche in Economia e Management Sanitario - CREMSUniversità Carlo Cattaneo - LIUCCastellanzaItalia

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