New Study Reports Enbrel (Etanercept) Significantly Improved Moderate to Severe Plaque Psoriasis in Children and Adolescents
"Moderate to severe plaque psoriasis is a chronic disease of the immune system that can significantly impact many aspects of the daily lives of children and teens," says Amy Paller, M.D., study investigator and Professor and Chair of Dermatology, Northwestern University School of Medicine. "These etanercept data are encouraging and reinforce the importance of continuing to investigate treatment options that may help this particularly vulnerable patient population manage their disease."
During the 48-week study, the percentage of patients achieving 75 percent or greater disease improvement from baseline, as measured by the standard Psoriasis Area and Severity Index (PASI 75), was used to evaluate the efficacy of ENBREL in patients between 4 and 17 years old. The primary efficacy endpoint was PASI 75 at week 12. There were 106 patients initially randomized to receive ENBREL and 105 patients randomized to receive placebo.
-- At week 12, which was the conclusion of the double-blind, placebo-controlled portion of the study, 57 percent (n=60) of pediatric patients treated with ENBREL achieved PASI 75, compared with 11 percent (n=12) of pediatric patients who received placebo (p less than 0.001).
-- At week 36, after 24 weeks of open-label treatment during which all patients in the study received ENBREL, PASI 75 was achieved by 68 percent (n=71) of the patients initially treated with ENBREL from the start of the study and 65 percent (n=67) of those who initially received placebo from the start of the study.
-- At the conclusion of the open-label treatment period (week 36), 138 patients were re-randomized to receive either ENBREL or placebo. During this period, patients who lost PASI 75 were re-treated and no patient had a rebound of psoriasis or a change in the type of their psoriasis.
There were no serious adverse events or serious infections during the 12-week placebo-controlled period and rates of adverse events were similar for ENBREL and placebo. During open-label treatment, three patients developed four serious adverse events. No deaths, cancers, opportunistic infections, tuberculosis or demyelination events were reported. The most common adverse events observed during the 48-week trial in patients treated with ENBREL were upper respiratory tract infection, headache, and nasopharyngitis.
This study was designed to assess the safety and efficacy of ENBREL therapy in children and adolescents between 4 and 17 years old with moderate to severe plaque psoriasis whose disease had been inadequately controlled with topical therapy or who received systemic therapy or phototherapy. In this 48-week study, 211 pediatric psoriasis patients were initially randomized to receive 12 once-weekly weight-based doses of ENBREL (0.8 mg/kg up to the intended dose of 50 mg) or placebo. After this double-blind portion, 208 patients entered a 24-week period of open-label ENBREL treatment once-weekly. At week 36, 138 patients were re-randomized to receive either ENBREL or placebo, to investigate withdrawal and re-treatment.
ENBREL is not indicated for the treatment of pediatric psoriasis. Amgen has filed a supplemental Biologics License Application (sBLA) with the U.S. Food and Drug Administration (FDA) for the use of ENBREL in treating pediatric patients with chronic moderate to severe plaque psoriasis who have tried another therapy. If approved by the FDA, ENBREL is expected to be the first biologic, as well as the first systemic medication, indicated to treat this disease in pediatric patients.
According to the National Institutes of Health, up to 7.5 million Americans have psoriasis, a noncontagious, chronic disease in which the immune system causes skin cells to grow at an accelerated rate. Approximately 80 percent of these patients have plaque psoriasis, which is characterized by painful and itchy, red, scaly patches. According to the National Psoriasis Foundation, about one-third of all psoriasis patients will develop the disease in childhood.
ENBREL is a fully human soluble tumor necrosis factor (TNF) receptor. ENBREL was first approved in 1998 for moderate to severe rheumatoid arthritis and has since been used in nearly 500,000 patients worldwide across indications.
-- ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderate to severe rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.
-- ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular-course juvenile rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs.
-- ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.
-- ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.
-- ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
What important information do I need to know about taking prescription Enbrel(R) (etanercept)?
ENBREL is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance your body's immune system makes called TNF. People with an immune disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, have too much TNF in their bodies. ENBREL can reduce the amount of TNF in the body to normal levels, helping to treat your disease. But, in doing so, ENBREL can also lower the ability of your immune system to fight infections. -0-
All medicines have side effects, including ENBREL. Possible side effects of ENBREL include: -- Serious infections - Many occurred in people prone to infection, such as those with advanced or poorly controlled diabetes - Some serious infections have been fatal - Rare cases of tuberculosis have occurred -- What not to do - Do not start ENBREL if you have an infection, such as an open sore or the flu, or are allergic to ENBREL or its components -- What to do - Tell your doctor if you are prone to infection or have had hepatitis B - Stop ENBREL if a serious infection occurs - Contact your doctor if you have questions about ENBREL or develop an infection - Tell your doctor if you have ever been treated for heart failure -- Serious nervous system disorders, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes - Tell your doctor if you have ever had any of these disorders or if you develop them after starting ENBREL -- Rare reports of serious blood disorders (some fatal) - Contact your doctor immediately if you develop symptoms, such as persistent fever, bruising, bleeding, or paleness -- In medical studies of all TNF blockers, including ENBREL, a higher rate of lymphoma (a type of cancer) was seen compared to the general population. The risk of lymphoma may be up to several-fold higher in rheumatoid arthritis and psoriasis patients - The role of TNF blockers, including ENBREL, in the development of lymphoma is unknown -- ENBREL can cause injection site reaction -- In a medical study of patients with JRA, infection, headache, abdominal pain, vomiting, and nausea occurred more frequently than in adults - The kinds of infections reported were generally mild and similar to those usually seen in children - Other serious adverse reactions were reported rarely, including serious infection (2 percent) and depression/personality disorder (1 percent)
If you have any questions about this information, be sure to discuss them with your doctor. Please visit www.enbrel.com or call 1-888-4ENBREL to request additional information, including the full U.S. Prescribing Information.
ABOUT AMGEN AND WYETH
Amgen and Wyeth Pharmaceuticals, a division of Wyeth, market ENBREL in North America. Wyeth markets ENBREL outside of North America. Immunex Corporation, a wholly owned subsidiary of Amgen, manufactures ENBREL.
Amgen discovers, develops and delivers innovative human therapeutics. A biotechnology pioneer since 1980, Amgen was one of the first companies to realize the new science's promise by bringing safe and effective medicines from lab, to manufacturing plant, to patient. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cancer, kidney disease, rheumatoid arthritis, and other serious illnesses. With a deep and broad pipeline of potential new medicines, Amgen remains committed to advancing science to dramatically improve people's lives. To learn more about our pioneering science and our vital medicines, visit www.amgen.com.
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Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products and non-prescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health. To learn more, visit www.wyeth.com.
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Posted: January 2008