[Infliximab: patients selection].
Patient selection is required in order to optimize therapy of moderate/severe psoriasis with infliximab, and must take into account individualized contraindications of the drug, its dosage and route of administration, efficacy variables, kinetics and maintenance of the therapeutic response and potential adverse effects of treatment (including infusion reactions) as well as their management. Response of psoriasis to infliximab is usually evident by the second week of treatment; thus, this would be the biologic of choice for patients requiring a fast response to treatment, either because of the severity of their psoriasis, its inflammatory component or the presence or likelihood of relapse or rebound. The response to the first induction phase of infliximab treatment (3 injections) seems to be better than that to repeated induction phases or intermittent treatment (on relapses), and in psoriasis the superiority of maintenance fixed-schedule treatment over intermittent (on demand) treatment has been shown. Thus, infliximab therapy must generally be intended from the start as long-term continuous treatment (provided the efficacy is maintained and no adverse effects appear), and such a therapeutic deal should be agreed upon with the patient and periodically reevaluated. Patients with severe psoriasis who require continuous systemic treatment and are highly dependent on it (with quick relapses on temporal discontinuation) would be the ideal candidates for the quickly effective, long-term maintenance treatment that constitutes the therapeutic goal with infliximab. The presence of psoriatic arthritis provides added support for infliximab therapy; otherwise, the use of this biologic agent must be cautiously pondered in any patient with an increased risk to develop any potential adverse effect or contraindication of infliximab (and TNF-blocking agents in general) during the course of treatment.
Puig
L
L
Servicio de Dermatología, Hospital de Santa Creu i Sant Pau, Barcelona, España. lpuig@santpau.es
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D000075202:Contraindications; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D018579:Patient Selection; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab