THERAPEUTICS BJD British Journal of Dermatology Patients with moderate-to-severe psoriasis recapture clinical response during re-treatment with etanercept J.-P. Ortonne, A. Taı ¨eb,* A.D. Ormerod, D. Robertson,à J. Foehl,à R. Pedersen,à C. Moltaà and B. Freundlichà University of Nice-Sophia Antipolis, Archet 11, 151 Route St Antoine de Ginestier ´e, BP 3079, Nice Cedex 3, France *Ho ˆpital Saint Andre, Bordeaux, France  Aberdeen Royal Infirmary, Aberdeen, Scotland àWyeth Research, Collegeville, PA, U.S.A. Correspondence Jean-Paul Ortonne. E-mail: ortonne@unice.fr Accepted for publication 3 April 2009 Key words efficacy, etanercept, psoriasis, re-treatment Conflicts of interest J.-P.O. has received reimbursements from Wyeth for symposia, speaking and consulting. A.T. has received reimbursement from Wyeth for organizing education and for research-related staffing. A.D.O. has received fees from Wyeth for speaking and research. D.R., J.F., R.P., C.M. and B.F. are employees of Wyeth and hold stock in Wyeth. DOI 10.1111/j.1365-2133.2009.09238.x Summary Background Patients with psoriasis experience remission and gradual reappearance of erythematous and scaly plaques and require individualized treatment over time. A goal of psoriasis treatment is to provide optimal efficacy with a flexible therapeutic regimen that may include treatment pauses. Objectives To determine whether patients receiving initial treatment with etanercept who then pause therapy would subsequently recapture response during re-treat- ment. Patients and methods A post-hoc analysis of 226 patients with moderate-to-severe pso- riasis from a large multicentre trial was performed. Patients had received etaner- cept 50 mg twice weekly subcutaneously until a target clinical response had been achieved, then had paused treatment and eventually relapsed. They were then re-treated with etanercept 25 mg twice weekly. The number of patients recaptur- ing a Physician Global Assessment (PGA) of psoriasis rating of £ 2 (clear, almost clear or mild) on first re-treatment was assessed. Patient satisfaction during the initial treatment and first re-treatment period was also determined. Results A total of 187 (83%) patients recaptured the target clinical response of a PGA of £ 2 after re-treatment. The majority of patients [219 of 226 (97%)] reported satisfaction with etanercept re-treatment. No new safety concerns emerged during re-treatment. Conclusions In this post-hoc analysis, patients with psoriasis who were re-treated with etanercept 25 mg twice weekly effectively recaptured clinical responses that patients found satisfactory. A flexible treatment option is available to dermatolo- gists and patients for individualized care. Psoriasis is a chronic disease in which the course of illness is typi- cally punctuated by remission and gradual reappearance of multi- ple erythematous and scaly plaques that are disfiguring, uncomfortable and distressing to patients. A long-term treatment strategy that can meet the individual needs and preferences of patients is required due to the nature of this disease. Many indi- viduals require the flexibility of a paused dose regimen as part of their long-term treatment programme. A paused dose regimen may be desired during the summer months when more sun exposure is available, or for elective surgery, illness or pregnancy. For significant psoriatic disease, administration of the older systemic treatments over time, such as ciclosporin and metho- trexate, is limited by risks of toxicities. Currently, four targeted biologics—etanercept, infliximab, adalimumab and ustekinumab—are approved in Europe for the treatment of moderate-to-severe plaque psoriasis; however, the use of monoclonal antibodies (mAbs) has been associated with the development of neutralizing antibodies 1,2 that limit the ability to maintain control over time without dose escalation or after treatment interruption. Treatment over 24 weeks with etaner- cept, a fully human tumour necrosis factor (TNF) soluble receptor blocker, was associated with antibodies in less than 2% of patients; 3,4 however, these were non-neutralizing anti- bodies, and there was no association between their formation and clinical efficacy. Therefore, paused administration of etan- ercept appears to be a viable and attractive treatment alterna- tive to other anti-TNF agents for selected patients requiring individualized care. As indicated in the European label, 5 re-treatment with etan- ercept in psoriasis is permissible and allows for a second Ó 2009 Wyeth Research 1190 Journal Compilation Ó 2009 British Association of Dermatologists • British Journal of Dermatology 2009 161, pp1190–1195