The itchy, red, and silvery skin patches that are the
hallmark of psoriasis were constant companions for Maria Anichini
from the age of 6.
At times they covered almost every inch of her body, causing her to choose
long sleeves and pants even in the broiling heat of summer so people wouldn't
But that all changed when Anichini, now age 20, began taking the injectable
biologic agent Enbrel several years ago after entering the first large study to
examine the drug's effectiveness in children and teens with moderate to severe plaque psoriasis. The
most common type of psoriasis is plaque psoriasis.
Anichini's lesions started to clear up almost immediately, and these days
the Columbia College junior is mostly free of them.
"It really is amazing," she tells WebMD. "I have some flare-ups
now and then, especially in the winter. But it is nothing like it was."
Her response to the drug was not unusual.
In the newly reported study in which she took part, 57% of children and
teens treated with Enbrel showed a 75% or greater improvement in skin
lesions and other symptoms after 12 weeks of treatment, compared with just
11% of kids who got placebo treatments.
Three out of four Enbrel-treated patients showed less dramatic, but still
significant, improvements in lesions, compared with one in four placebo-treated
The study appears in the Jan. 17 issue of The New England Journal of
"We were surprised at how good the responses were because we used pretty
low doses [of Enbrel]," says Northwestern University dermatology and
pediatrics professor Amy Paller, MD, who led the study, which was funded by
Enbrel makers Amgen and Wyeth Pharmaceuticals.
Enbrel and Psoriasis
Approved by the FDA in the spring of 2004 for the treatment of psoriasis in
adults, Enbrel blocks a key chemical messenger in the immune system linked to
inflammation known as tumor necrosis factor-alpha (TNF-alpha).
It is now believed that inflammation plays a major role in a host of immune
system diseases, including psoriasis.
Enbrel has been approved for the treatment of juvenile rheumatoid arthritis , but it had
not been studied in children with psoriasis until now, Paller tells WebMD.
The study included 211 children and teens from 42 sites in the U.S. and
Canada treated during the first 12 weeks with either once-weekly injections of
placebo or up to 50 milligrams of Enbrel, depending on body
After the initial 12 weeks of treatment, all the patients were treated with
Enbrel for the following 24 weeks; then patients were again randomly assigned
to treatment with either Enbrel or placebo for an additional 12 weeks to
examine the effect of withdrawal.
The researchers reported that 68% of patients initially treated with Enbrel
and 65% of those initially treated with placebo showed 75% improvement in
lesions and other symptoms at week 36 of the trial.
Withdrawal from the drug was associated with a significant return of
psoriasis lesions in 42% of patients.
"Our responses were as good as those seen in studies in adults with
about half the dosage," Paller says. "We really don't know why that
Dermatologist and psoriasis expert Mark G. Lebwohl, MD, says he is not
surprised by the findings.
"[Enbrel] has become the leading systemic treatment for adults with
psoriasis in the U.S., so you would expect it to work just as well in
children," he says.
He adds that the safety of the drug in children has been shown in juvenile
rheumatoid arthritis studies.
The chairman of the dermatology department at New York City's Mount Sinai
Medical Center, Lebwohl tells WebMD that while many patients show dramatic
improvement while taking biologic drugs like Enbrel, Remicade,
Humira, and Raptiva, a significant percentage does not.
He says more drugs are eeded and cites certain investigational drugs as
being particularly promising for the treatment of psoriasis.
"The effects [in clinical trials] have been quite dramatic, and they
seem to work for almost everybody," he says.
By Salynn Boyles
Reviewed by Louise Chang
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