Infliximab in the Management of Psoriasis in Patients Previously Treated with Other Biologic Agents

Abstract

Objective

To determine the efficacy of infliximab in psoriatic patients with moderate to severe disease who failed to respond, relapsed, or experienced an adverse event with other biologics.

Methods

We evaluated 19 patients with plaque-type psoriasis. Ten also suffered from psoriatic arthritis. All subjects had been previously treated with one or more biologics and discontinued treatment either because of no response or adverse events from the precedent therapy. We evaluated the Psoriatic Area and Severity Index (PASI) score as a response to treatment.

Results

Overall, there was a statistically significant reduction in PASI (P = 0.002). At week 14, 88% had achieved PASI 50, 61% PASI 75, and 44% PASI 90. At this time point, no patient had discontinued treatment for any reason. Before completion of the first year of treatment, four patients discontinued infliximab because they had not seen any response. At week 78, the result remained the same as at week 14, taking into consideration the bias caused by some patients' discontinuation. Two patients discontinued because of serious adverse events.

Conclusions

In the small cohort of patients with moderate to severe psoriasis refractory to other biologics, infliximab is an important and safe therapeutic pathway. Differences in chemical structure, mode of action, or immunogenicity could explain the successful change to infliximab. The expanding use of biologics in clinical dermatology will allow us to describe and delineate more fully the benefit of switching from one biologic agent to another.