Adalimumab for Adult Patients with Plaque Psoriasis: A Review of Clinical Effectiveness [Internet]

Psoriasis is an autoimmune and inflammatory disease with genetic predispositions that generally occurs before age 35. The development of the disease is driven by multiple pathways of immune mediators, including tumor necrosis factor-α (TNF-α), interleukin (IL)-23 and IL-17 cytokines. Psoriasis affects about 3% of the population and is associated with systemic diseases including inflammatory bowel disease, metabolic syndrome, and cardiovascular disease. Plaque psoriasis is the most common form of the disease, accounting for about 70% to 90% of all patients with psoriasis., It is characterized by itchy, red, scaly, raised lesions on the skin, especially on the scalp, elbows, knees, scalp, and back extensor extremities and trunk. Psoriasis significantly impairs patients’ quality of life.Most patients with plaque psoriasis have mild disease that is adequately managed with topical application of corticosteroids, emollients, vitamin D analogs, coal tar products, retinoids and calcineurin inhibitors, or phototherapy. Moderate-to-severe chronic plaque psoriasis symptoms are generally treated with systemic therapies., They have a significant negative impact on patient quality of life., and are associated with a considerable economic burden., Treatment options include conventional agents such as methotrexate and cyclosporine, and relatively newer biologic agents. Biologics approved for patients with moderate-to-severe plaque psoriasis include of TNF-α inhibitors (e.g., as adalimumab and infliximab), IL-17 inhibitors (e.g., ixekizumab, and secukinumab) and IL-23 inhibitors (e.g., risankizumab).,,– Unlike the non-specific conventional immunomodulators, biologic treatments for psoriasis are less likely to cause systematic adverse events because of their specificity for immune targets.,Adalimumab was among the earlier biologic agents that received approval from Health Canada for the treatment of severe plaque psoriasis. Others with similar approved indications include infliximab, ixekizumab, risankizumab, and secukinumab. The variety of biologic agents currently available for the treatment of moderate-to-severe plaque psoriatic presents a challenge to clinicians in making choices that optimize patients’ outcomes. It also creates the need for decision-makers to determine suitable places in therapy for the available treatment options, using evidence-based information. In 2008, CADTH conducted a Common Drug Review (CDR) of adalimumab in patients with plaque psoriasis. However, that review did not cover the comparative effectiveness of adalimumab to other biologics for that indication.The aim of this Rapid Response review is to compare and summarize evidence about the clinical effectiveness of adalimumab versus other biologic drugs indicated for the treatment of in adult patients with plaque psoriasis.

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