[Efficacy of treatment with infliximab in patients with moderate-severe psoriasis and high needs of therapy. A retrospective study of 43 patients].
BACKGROUND
Much of the information on efficacy and safety of infliximab comes from clinical trials, but reports on clinical practice with patients with high therapeutic needs, for whom infliximab is approved according to the EMEA label, are scarce.


OBJECTIVE
The evaluation of efficacy of infliximab treatment in patients with moderate-to-severe psoriasis and high therapeutic needs in daily practice at a reference Dermatology Department of a teaching hospital in Barcelona, Spain.


METHODS
We reviewed the clinical records of 43 patients with moderate-to-severe psoriasis (Psoriasis Area and Severity Index [PAS]I>10) with failure, contraindication or intolerance to other systemic treatments who started infliximab therapy between 2004 and 2007 and completed at least 2 infusions.


RESULTS
We treated 43 patients (28 men and 15 women) with a mean baseline PASI of 23.7. Five patients received two courses of infliximab, therefore 48 courses of treatment were evaluated, with a mean number of infusions of 7.7 (range 3 to 25). Sixteen patients have been receiving continuous treatment for more than one year; PASI-75 and PASI-90 responses have been achieved by week 48 and maintained by 87.5% and 68.8% of those patients, respectively. We have observed loss of clinical efficacy (PASI<50 of baseline) during the course of treatment in 9 patients (20.9%). In 16 of the first courses of treatment (37.2%) and 5 (100%) of the second courses combination therapy with low doses of methotrexate, ciclosporin or acitretin was given to optimize the therapeutic result. The interval between infusions had to be shortened to 6 weeks in 7 patients receiving one course of treatment (16.3%) and in 2 patients on their second course of treatment (40%). Infusion reactions occurred in 9 patients (20.9%). Nine successful therapeutic courses were stopped on patient's decision; 6 of these patients (66.7%) presented a relapse (loss of PASI-50 response) within 6 months. Treatment failures were seen in 7 patients (16.3%) due to non-recoverable loss of efficacy (2 cases) severe acute infusion reaction alone (2 cases) or in association with loss of efficacy (relapse/rebound) (3 cases).


CONCLUSIONS
Infliximab treatment was successful in 83.7% of our patients; 16 of them (37%) have been under continuous treatment for more than one year. Combination with systemic treatment and/or increase in the frequency of infusions contributed to attain an excellent response (PASI<3) in most cases. Relapses within the first 6 months after treatment withdrawal were seen in 2/3 of patients, but second courses of treatment achieved the same degree of efficacy, even though it usually was delayed with respect to the first course of therapy and required concomitant administration of combined systemic therapy.
Puig
L
L
Servicio de Dermatología, Hospital de Santa Creu i Sant Pau, Barcelona, España. lpuig@santpau.es
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D008991:Monitoring, Physiologic; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D000069285:Infliximab