title: Long-term durability and dose escalation patterns in infliximab therapy for psoriasis.
abstract: BACKGROUND
  Infliximab often requires dose escalation to maintain response. Studies regarding long-term durability and dose escalation patterns for psoriasis are few.
  
  
  OBJECTIVE
  We sought to evaluate dose escalation patterns in psoriatic patients to identify factors of lack of optimal response to infliximab.
  
  
  METHODS
  A retrospective cohort study included 93 patients (216.3 patient-years) treated with infliximab for psoriasis. Kaplan-Meier analysis assessed drug durability.
  
  
  RESULTS
  A median infliximab dose of 5.42 mg/kg/mo (range: 2.71-10.83) for a mean of 28 months was administered. Two thirds of patients received a dose escalation. Concurrent methotrexate extended duration of therapy (by a mean ± SD of 19.5 ± 8.1 months, P = .034), including time until first dose escalation (by a mean ± SD of 12.0 ± 6.1 months, P = .037), and failure (by a mean ± SD of 20.7 ± 6.7 months, P = .034). Patients who increased the infusion frequency before increasing the dose remained on infliximab 8.4 months longer than those who first increased the dose (P = .045). Four patients experienced adverse events; 2 required discontinuation.
  
  
  CONCLUSIONS
  Psoriasis Area and Severity Index, infliximab levels, and antibody titers were not measured.
  
  
  CONCLUSIONS
  Dose escalation optimizes durability of infliximab. The probability of maintaining response is enhanced by concomitant methotrexate and increasing the infusion frequency before increasing the dose.
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Luber
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Tsui
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Heinecke
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Lebwohl
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Jacob.levittmd@gmail.com.
authors.forename: Jacob O
authors.initials: JO
authors.lastname: Levitt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D015331:Cohort Studies; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D020714:Maximum Tolerated Dose; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D000069285:Infliximab; D008727:Methotrexate
keywords: anti-infliximab antibodies; dose escalation; dose intensification; human antichimeric antibodies; infliximab; methotrexate; psoriasis