***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous studies of infliximab in psoriasis have demonstrated rapid improvement with induction therapy and sustained response with regularly administered maintenance therapy . OBJECTIVE The efficacy and safety of continuous ( every-8-week ) and intermittent ( as-needed ) maintenance regimens were compared . METHODS Patients with moderate-to-severe psoriasis ( n = 835 ) were r and omized to induction therapy ( weeks 0 , 2 , and 6 ) with infliximab 3 mg/kg or 5 mg/kg or placebo . Infliximab-treated patients were r and omized again at week 14 to continuous or intermittent maintenance regimens at their induction dose . RESULTS At week 10 , 75.5 % and 70.3 % of patients in the infliximab 5 mg/kg and 3 mg/kg groups , respectively , achieved PASI 75 ; 45.2 % and 37.1 % achieved PASI 90 ( vs 1.9 % [ PASI 75 ] and 0.5 % [ PASI 90 ] for placebo ; P < .001 ) . Through week 50 , PASI responses were better maintained with continuous compared with intermittent therapy within each dose , and with 5 mg/kg compared with 3 mg/kg continuous therapy . LIMITATIONS Longer term ( > 1 year ) maintenance therapy and further study of  infliximab serum concentrations over this period , in both PASI 75 responders and non-responders , would be preferable . CONCLUSIONS Through week 50 , response was best maintained with continuous infliximab therapy . Infliximab was generally well-tolerated in most patients Background The anti‐interleukin‐12/23p40 monoclonal antibody briakinumab has been shown in a phase II study to be effective psoriasis treatment Background The tumour necrosis factor‐α antagonist etanercept and the interleukin (IL)‐12/23p40 antagonist ustekinumab have been shown to be effective psoriasis therapies . The IL‐12/23p40 antagonist briakinumab was shown to be effective psoriasis treatment in a phase II study BACKGROUND Chronic plaque psoriasis is frequently associated with obesity . The effect of a hypoenergetic diet on psoriasis has not been investigated . OBJECTIVE The objective was to investigate whether moderate weight loss ( ie , 5 - 10 % of body weight ) increases the therapeutic response to a low dose of cyclosporine in obese patients with moderate-to-severe chronic plaque psoriasis . DESIGN A 24-wk r and omized , controlled , investigator-blinded clinical trial was conducted in 61 patients . The efficacy of 2.5 mg x kg(-1)d(-1 ) cyclosporine combined with a low-calorie diet ( intervention group ) was compared with cyclosporine alone ( control group ) in obese patients [ body mass index ( in kg/m(2 ) ) > 30 ] with moderate-to-severe psoriasis . The primary endpoint was an improvement from baseline of > or=75 % in the Psoriasis Area and Severity Index ( PASI 75 response ) at week 24 . RESULTS At week 24 , the mean ( + /- SD ) reduction in body weight was 7.0 % + /- 3.5 in the intervention group and was 0.2 % + /- 0.9 in the control group ( P < 0.001 ) . The PASI 75 response was achieved by 20 of 30 patients ( 66.7 % ) treated with cyclosporine plus a low-calorie diet and by 9 of 31 ( 29.0 % ) patients treated with cyclosporine alone ( P < 0.001 ) . Four patients ( 13.3 % ) from the intervention group and 14 ( 45.1 % ) from the control group withdrew prematurely from the study ( P < 0.001 ) . CONCLUSIONS Obese patients with moderate-to-severe psoriasis increase their response to low-dose cyclosporine if a calorie-controlled diet is included in the treatment regimen . Lifestyle modifications , including a low-calorie diet , may supplement the pharmacologic treatment of obese psoriasis patients . This trial was registered at clinical trials.gov as NCT00512187 BACKGROUND High-dose cyclosporine therapy significantly alleviates psoriasis within 2 to 4 weeks but is associated with a high rate of side effects . Reports are conflicting on the frequency and promptness of relapse after discontinuation of cyclosporine therapy . OBJECTIVE Our purpose was to compare the efficacy and safety of low-dose cyclosporine with that of etretinate and the stability of remission after replacing cyclosporine therapy with topical anthralin during tapering of cyclosporine . METHODS In a multicenter study 210 patients with moderate to severe chronic plaque-type psoriasis were r and omly assigned to treatment with cyclosporine or etretinate . The initial dosages were 2.5 mg/kg/day for cyclosporine and 0.5 mg/kg/day for etretinate , which could be individually adjusted to 5.0 and 0.75 mg/kg/day , respectively . After a treatment phase of 10 weeks ( phase 1 ) patients receiving cyclosporine were again r and omly assigned to a group in which cyclosporine was replaced by topical dithranol ( anthralin ) , or to another group in which the drug was tapered during the next 12 weeks ( phase 2 ) . All patients treated with etretinate discontinued therapy after 10 weeks and used topical dithranol . RESULTS Mean Psoriasis Area and Severity Index decreased by 71 % in the cyclosporine group and by 47 % in the etretinate group during phase 1 . After 10 weeks of treatment 47 % of the patients treated with cyclosporine and 10 % of those treated with etretinate showed a reduction of more than 80 % in skin involvement . Sixty-four percent of the cyclosporine group and 48 % of the etretinate group did not require an increase in the initial dosage , result ing in a mean daily dose of 3.0 and 0.53 mg/kg , respectively . There was significant alleviation of nail involvement and joint complaints in both groups . In phase 2 the increase in mean Psoriasis Area and Severity Index and the incidence of relapse were significantly higher in patients in whom cyclosporine was discontinued and replaced by dithranol than in patients in whom cyclosporine was tapered or who were pretreated with etretinate . During treatment four patients from the cyclosporine group and three patients of the etretinate group discontinued the study because of side effects . CONCLUSION Low-dose short-term cyclosporine therapy for psoriasis is , in comparison with etretinate , highly effective and well tolerated . Individually adjusted cyclosporine therapy allows the majority of patients to continue the low dosage of 2.5 mg/kg/day and still achieve a good clinical response . Remission can be better preserved by tapering the drug than by discontinuing treatment abruptly BACKGROUND Psoriasis vulgaris may benefit from treatment with fumaric acid and /or its derivatives ; however , because different preparations have been used , results have been contradictory and difficult to interpret . OBJECTIVE The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives . METHODS A r and omized double-blind study was carried out in patients with psoriasis , comparing a well-characterized formulation of fumaric acid derivatives with placebo . RESULTS The results indicated statistically significant superiority of the fumaric acid derivatives over placebo .  Adverse events ( flush , gastrointestinal disturbances ) were initially relatively frequent , but decreased thereafter . CONCLUSION Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis BACKGROUND Inflammatory cytokines such as tumor necrosis factor ( TNF ) have been implicated in the pathogenesis of psoriasis . We evaluated the safety and efficacy of etanercept , a TNF antagonist , for the treatment of plaque psoriasis . METHODS In this 24-week , double-blind study , 672 patients underwent r and omization and 652 either received placebo or received etanercept subcutaneously at a low dose ( 25 mg once weekly ) , a medium dose ( 25 mg twice weekly ) , or a high dose ( 50 mg twice weekly ) . After 12 weeks , patients in the placebo group began twice-weekly treatment with 25 mg of etanercept . The primary measure of clinical response was the psoriasis area- and -severity index . RESULTS At week 12 , there was an improvement from base line of 75 percent or more in the psoriasis area- and -severity index in 4 percent of the patients in the placebo group , as compared with 14 percent of those in the low-dose -- etanercept group , 34 percent in the medium-dose -- etanercept group , and 49 percent in the high-dose-etanercept group ( P<0.001 for all three comparisons with the placebo group ) . The clinical responses continued to improve with longer treatment . At week 24 , there was at least a 75 percent improvement in the psoriasis area- and -severity index in 25 percent of the patients in the low-dose group , 44 percent of those in the medium-dose group , and 59 percent in the high-dose group . The responses as measured by improvements in the psoriasis area- and -severity index were paralleled by improvements in global assessment s by physicians and the patients and in quality -of-life measures .  Etanercept was generally well tolerated . CONCLUSIONS The treatment of psoriasis with etanercept led to a significant reduction in the severity of disease over a period of 24 weeks BACKGROUND Recognition of psoriasis as a T-cell-mediated immune disease has led to the development of various therapeutic approaches directed against the pathogenic T cells . Alefacept , a novel and selective biological recombinant protein , binds CD2 on T cells to block T-cell activation and proliferation and interacts with FcgammaRIII receptors on accessory cells to produce selective T-cell apoptosis . OBJECTIVE To demonstrate the efficacy and safety of once-weekly alefacept IM compared with placebo given for 12 weeks to patients with chronic plaque psoriasis . METHODS Multicentre ( 63 sites in Europe , the USA , and Canada ) , r and omized , double-blind , parallel-group study comparing 10 mg and 15 mg of alefacept and placebo administered IM once weekly for 12 weeks . Patients were followed for an additional 12 weeks after cessation of therapy . Patients were eligible for enrollment if they were > or = 18 years of age , had chronic plaque psoriasis for > or = 12 months involving > or = 10 % body surface area , and had CD4 + T-cell counts at or above the lower limit of normal . RESULTS 507 patients were enrolled into three treatment groups , which were well balanced for demographic , baseline disease characteristics , and treatment history . A significantly greater percentage of patients treated with alefacept 15 mg IM achieved > or = 75 % PASI reduction from baseline 2 weeks after the last dose compared with placebo ( 21 % vs. 5 % , P < 0.001 ) ; 12 % of patients treated with alefacept 10 mg IM reached this level of improvement ( P = NS vs. placebo ) . Alefacept was well tolerated , with adverse events similar to that of placebo . CONCLUSIONS Treatment with alefacept 15 mg IM provided highly significant improvements in all measures of psoriasis disease activity compared with placebo . Pharmacodynamic data confirmed that alefacept is a selective biological agent that reduces memory-effector T cells ( CD4+CD45RO+ and CD8+CD45RO+ ) , the source of the pathogenic mediators of psoriasis , while having relatively no effect on naive T-cell population BACKGROUND Tumour necrosis factor alpha ( TNFalpha ) is thought to play a part in the pathogenesis of psoriasis . We assessed the efficacy and safety of continuous treatment with infliximab , a monoclonal antibody that binds to and neutralises the activity of TNFalpha , in patients with psoriasis . METHODS In this phase III , multicentre , double-blind trial , 378 patients with moderate-to-severe plaque psoriasis were allocated in a 4:1 ratio to receive infusions of either infliximab 5 mg/kg or placebo at weeks 0 , 2 , and 6 , then every 8 weeks to week 46 . At week 24 , placebo-treated patients crossed over to infliximab treatment .  Skin and nail signs of psoriasis were assessed using the psoriasis area and severity index ( PASI ) and nail psoriasis severity index ( NAPSI ) , respectively . The primary endpoint , analysed on an intention-to-treat-basis , was the proportion of patients achieving at least a 75 % improvement in PASI from baseline to week 10 . FINDINGS At week 10 , 80 % ( 242/301 ) of patients treated with infliximab achieved at least a 75 % improvement from their baseline PASI ( PASI 75 ) and 57 % ( 172/301 ) achieved at least a 90 
    Output:
    
These biologics are more effective than etanercept and all conventional treatments .
Head-to-head trials indicate the superiority of adalimumab and infliximab over methotrexate ( MTX ) , the superiority of ustekinumab over etanercept , the nonsignificant superiority of ciclosporin over MTX , and the dose-dependent efficacy of etanercept and ustekinumab .
Fumaric acid is as efficacious as MTX .
In conclusion , the qualitative and quantitative evidence is much stronger for biological interventions than for conventional treatments