title: Infliximab improves health-related quality of life in the presence of comorbidities among patients with moderate-to-severe psoriasis.
abstract: BACKGROUND
  Psoriasis affects patients both physically and psychologically.
  
  
  OBJECTIVE
  To investigate the effect of comorbidities on health-related quality of life (HRQoL) and to determine whether infliximab improved HRQoL in the presence of these conditions.
  
  
  METHODS
  In this multicentre, double-blind study, 835 patients with moderate-to-severe plaque psoriasis were randomized to receive infliximab 3 or 5 mg kg(-1) or placebo at weeks 0, 2 and 6. Infliximab-treated patients were re-randomized at week 14 to receive the same treatment every 8 weeks or as needed through week 46; placebo patients crossed over to infliximab 5 mg kg(-1) at week 16. Disease severity (Psoriasis Area and Severity Index, PASI) and HRQoL (Dermatology Life Quality Index, DLQI; 36-item Short-Form Health Survey, SF-36) were measured at various time points. The effect of patient comorbidities on baseline HRQoL was assessed using multiple regression models. The impact of key comorbidities on infliximab treatment effect was also assessed.
  
  
  RESULTS
  Disease severity (PASI), depression and psoriatic arthritis (PsA) were predictors of poor baseline HRQoL. At week 10, infliximab 3 and 5 mg kg(-1) significantly improved physical and mental health dimensions of the SF-36 and the DLQI (all P < 0.001). Consistent improvement in HRQoL with infliximab treatment was observed regardless of baseline patient characteristics or comorbidities. Through week 50, HRQoL and PASI scores were most improved with infliximab 5 mg kg(-1) administered every 8 weeks.
  
  
  CONCLUSIONS
  Disease severity, depression and PsA were significant predictors of poor HRQoL. Infliximab significantly improved HRQoL, regardless of these characteristics.
authors.affiliation: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. sfeldman@wfubmc.edu
authors.forename: S R
authors.initials: SR
authors.lastname: Feldman
authors.forename: A B
authors.initials: AB
authors.lastname: Gottlieb
authors.forename: M
authors.initials: M
authors.lastname: Bala
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.forename: D
authors.initials: D
authors.lastname: Eisenberg
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: A
authors.initials: A
authors.lastname: Menter
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D018434:Sickness Impact Profile; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069285:Infliximab