title: Sequential use of infliximab and etanercept in generalized pustular psoriasis.
abstract: Generalized pustular psoriasis is a dramatic potentially life-threatening psoriasis variant and represents a major therapeutic challenge. Tumor necrosis factor alpha (TNF-alpha) inhibitors have been shown to be highly effective in psoriasis vulgaris and psoriasis arthritis. Currently, TNF-alpha can be targeted therapeutically by 2 different approaches. TNF-alpha antibodies show a fast onset of action and a long-lasting activity. Soluble TNF-alpha receptors have a slower onset and a shorter duration of activity, which allows a rapid cessation of the drug's activity in the case of adverse events. Here we report that a remission of generalized pustular psoriasis achieved by the TNF-alpha antibody infliximab was maintained by long-term application of the soluble TNF-alpha receptor etanercept. Sequential therapy with TNF-alpha antibodies and TNF-alpha receptors may represent a novel concept that combines a rapid onset of action in the initiation therapy with a lower risk for severe adverse events in the maintenance treatment of pustular psoriasis.
authors.affiliation: Department of Dermatology, Ludwig-Maximilians-University, Munich, Germany. peter.weisenseel@med.uni-muenchen.de
authors.forename: Peter
authors.initials: P
authors.lastname: Weisenseel
authors.forename: Jörg Christoph
authors.initials: JC
authors.lastname: Prinz
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab