Adalimumab

▴ Adalimumab, a fully human monoclonal antibody, is a tumour necrosis factor antagonist that has been investigated for efficacy in psoriatic arthritis, based on well-established use of the drug in rheumatoid arthritis. ▴ In well-controlled Phase III trials, adalimumab (40 mg administered subcutaneously every other week) has shown efficacy in adult patients with psoriatic arthritis who had an inadequate response to previous treatment with NSAIDs (24-week ADEPT trial; n = 313) or disease-modifying antirheumatic drugs (12-week study; n = 100). ▴ In these trials, adalimumab recipients experienced a significantly greater improvement in arthritis response (p < 0.001 in the ADEPT trial, and p ≤ 0.05 in the smaller study) than placebo recipients, as assessed by the ACR20, ACR50 and ACR70 response rates. ▴ There was radiographic evidence of progressive joint damage in the placebo group but not the adalimumab group at 24 weeks in the ADEPT trial, according to the mean total Sharp score modified for psoriatic arthritis. ▴ The signs and symptoms of psoriasis in patients with psoriatic arthritis were clinically and statistically more improved with adalimumab than with placebo, according to the PASI responses, at 12 and 24 weeks in the ADEPT trial (e.g. PASI50 rate 75% vs 12% at 24 weeks; p < 0.001). ▴ Adalimumab was generally well-tolerated in clinical trials of psoriatic arthritis; the adverse event profile appears to be similar to that associated with use of the drug in rheumatoid arthritis.