title: Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial.
abstract: BACKGROUND
  Psoriasis has a well-documented, markedly negative effect on patient quality of life.
  
  
  OBJECTIVE
  To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis.
  
  
  METHODS
  The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg(-1) induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen.
  
  
  RESULTS
  At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores (P < 0.001) and SF-36 physical and mental component summary scores (P < 0.001) than placebo-treated patients. Significant improvement (P < 0.001) was also seen in all eight SF-36 subscales, and was greatest for the "Bodily Pain" and "Social Functioning" scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 (P < 0.001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50.
  
  
  CONCLUSIONS
  Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement.
authors.affiliation: Department of Dermatology, Georg-August University, Göttingen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Reich
authors.forename: F O
authors.initials: FO
authors.lastname: Nestle
authors.forename: K
authors.initials: K
authors.lastname: Papp
authors.forename: J-P
authors.initials: JP
authors.lastname: Ortonne
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.forename: M
authors.initials: M
authors.lastname: Bala
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.forename: C
authors.initials: C
authors.lastname: Guzzo
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.forename: L T
authors.initials: LT
authors.lastname: Dooley
authors.forename: C E M
authors.initials: CE
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D011594:Psychometrics; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab