Paradoxical worsening of psoriasis when switching from etanercept to adalimumab: a case series.

BACKGROUND: Etanercept and adalimumab are the most widely used biologic agents for psoriasis today. Large phase III trials have elucidated the much higher efficacy of adalimumab over etanercept; however, no head-to-head comparison data exist for these two medications. OBJECTIVE: We report four cases of patients well controlled with Enbrel who flared when switched to adalimumab. In all four cases, the patient's psoriasis improved when switched back to etanercept. CONCLUSION: This brief report is intended to alert clinicians of the possibility that, despite the well-known average efficacy advantage of adalimumab over etanercept, some psoriasis patients experience better clinical outcome with etanercept than adalimumab. Therefore, despite the general efficacy difference between these two TNF inhibitors, it may be worth keeping in mind etanercept as an option in patients who have failed with adalimumab.