Background Adalimumab and ustekinumab have demonstrated high effectiveness in the treatment of moderate-severe psoriasis in randomised controlled trials. There is, however, limited data available on the comparative effectiveness of ustekinumab and adalimumab in psoriasis patients unsuccessfully treated with a first biologic line with etanercept.

Purpose To evaluate the comparative effectiveness of adalimumab and ustekinumab in patients previously treated with etanercept using PASI 90 score.

Material and methods A single-centre, retrospective, observational, comparative study was carried out from 1 November 2011 to 31 November 2015. Participants were patients with moderate-severe psoriasis that, after unsuccessful etanercept therapy, were treated with adalimumab or ustekinumab. An unblinded revision of each patient’s clinical history was carried out to assess clinical data.

The primary analysis compared the percentages of patients in each treatment group who achieved ≥90% improvement from baseline PASI score (PASI 90) at week 12. Secondary endpoints included percentages of patients with PASI 90 at week 96. Statistical analysis was performed with the SPSS 22.0 software.

Results Thirty-four psoriasis patients were included in the study: 15 (44.1%) patients received adalimumab and 19 (55.9%) received ustekinumab as a second-line therapy.

The median age in adalimumab and ustekinumab group were 58 (SD 6.7) and 50 years (SD 17.3) (p=0.08).

After 12 weeks of study treatment, 68.4% of ustekinumab-treated patients (13/19) achieved a PASI 90 response against 46.6% (7/15) in the adalimumab group (p=0.2). At week 96, more patients had a PASI 90 in the ustekinumab group compared with the adalimumab group, but the difference was not statistically significant (68.4% versus 46.6%; p=0,2).

Conclusion Previously studies have shown that adalimumab and ustekinumab are effective after anti-TNF inhibitors’ therapy.

However, to our knowledge, the present study is the first to evaluate the comparative effectiveness measured as PASI 90 of ustekinumab and adalimumab in psoriasis patients that failed with etanercetp.

Our results suggests that there is no significant difference in the efficacy of ustekinumab between ustekinumab and adalidumab in the percentage of patients achieving PASI90. Of course, these results need to be evaluated with randomised and prospective clinical trials.

References and/or Acknowledgements 1. J Dermatolog Treat2015;26(3):217–22.

2. J Eur Acad Dermatol Venereol2011;25(9):1037–40.

No conflict of interest