A controlled trial found that in patients with psoriasis and psoriatic arthropathy, initial treatment with etanercept twice weekly cleared skin lesions faster than once weekly but had little effect on joint and tendon symptoms.

Etanercept is effective in treatment of psoriasis and psoriatic arthropathy, and may be given either as twice weekly doses of 12 weeks followed by weekly doses, or weekly doses from start. The objective of this study was to determine whether either regimen was superior in patients with both skin and joint symptoms. Participants were adults with active but stable moderate to severe psoriasis and active psoriatic arthropathy. They were randomised to etanercept 50mg once or twice weekly for 12 weeks, with matching placebo in the once weekly group to maintain blinding. After the 12 week study period, all received open-label once weekly etanercept for a further 12 weeks. Primary outcome was the proportion of participants who achieved "clear" or "almost clear" on the physician’s global assessment of psoriasis at week 12 (rated 0 to 5 where 0 = clear skin). Secondary outcomes included other measures of skin disease and measures of arthropathy.

There were 754 patients randomised, of whom 2 did not receive any study drug and were excluded from analyses. Withdrawal rates were similar in both weekly (n=373) and twice weekly (n=379) groups, 7.5% and 7.9% respectively, and were mainly due to adverse effects.

At 12 weeks, more patients in the twice weekly group had clear or almost clear skin scores, 46% vs. 32% (P<0.001). There was no significant difference, however, in the proportions of patients responding to the arthropathy criteria (77% vs. 76%), and arthropathy symptoms improved to a similar extent in both groups. There were no unexpected adverse effects and no significant difference between the groups in tolerance.

The authors conclude that in patients with psoriasis and psoriatic arthropathy, initial etanercept treatment with twice weekly dosing leads to faster clearance of skin lesions. It does not, however, significantly affect arthropathy symptoms. They conclude that this study will allow etanercept treatment to be better tailored to the clinical needs of individual patients.