title: Treatment of palmoplantar psoriasis with infliximab: a randomized, double-blind placebo-controlled study.
abstract: BACKGROUND
  Palmoplantar psoriasis is a difficult to treat variant of plaque psoriasis.
  
  
  OBJECTIVE
  To study the safety and efficacy of infliximab in non-pustular palmoplantar psoriasis.
  
  
  METHODS
  Patients with non-pustular palmoplantar psoriasis affecting at least 10% of their palms and soles and with a modified palmoplantar psoriasis area and severity index (m-PPPASI) of at least eight were recruited. Patients were randomized (1:1) to receive infliximab 5 mg/kg or placebo at weeks 0, 2 and 6. Patients initially randomized to placebo received infliximab at weeks 14, 16 and 20 whereas patients randomized to infliximab received additional infliximab infusions every 8 weeks until week 22.
  
  
  RESULTS
  Twenty four (24) patients were randomized in this study. At week 14, 33.3% and 66.7% of patients treated with infliximab achieved m-PPPASI 75 and m-PPPASI 50 respectively compared to 8.3% for both m-PPPASI 75 (P = 0.317) and m-PPPASI 50 (P = 0.009) for patients randomized to placebo. A reduction of 50.3% in the mean surface area of palms and soles affected with psoriasis was seen at week 14 in patients randomized to infliximab as compared to an increase of 14.9% in patients randomized to placebo (P = 0.009).
  
  
  CONCLUSIONS
  This pilot study did not reach its primary endpoint of m-PPPASI 75 at week 14. However, infliximab was observed to be more efficacious than placebo in improving PPSA and with respect to the percentage of patients reaching m-PPPASI 50 at week 14. Larger and longer term studies are needed for severe patients to better assess the efficacy of infliximab in palmoplantar psoriasis.
authors.affiliation: Innovaderm Research Inc., Sherbrooke est, Montreal, QC, Canada. rbissonnette@innovaderm.ca
authors.forename: R
authors.initials: R
authors.lastname: Bissonnette
authors.forename: Y
authors.initials: Y
authors.lastname: Poulin
authors.forename: L
authors.initials: L
authors.lastname: Guenther
authors.forename: C W
authors.initials: CW
authors.lastname: Lynde
authors.forename: C
authors.initials: C
authors.lastname: Bolduc
authors.forename: S
authors.initials: S
authors.lastname: Nigen
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D002170:Canada; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005528:Foot / Q000473:pathology*; D006225:Hand / Q000473:pathology*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010919:Placebos; D011565:Psoriasis / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D010919:Placebos; D000069285:Infliximab