Infliximab, a tumor necrosis factor α antagonist, has recently been shown to be successful for the short-term treatment of generalized pustular psoriasis (GPP) in multiple case reports.
Objective:
The goal of this case series was to assess the efficacy of the longer-term management of GPP with infliximab.
Methods:
Three patients with severe GPP were followed to assess the efficacy of long-term treatment with infliximab.
Results:
Infliximab therapy was more efficacious with infusion every 6 to 8 weeks in combination with methotrexate.
Conclusion:
Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.
Get full access to this article
View all access options for this article.
References
1.
BakerHRyanT. Generalized pustular psoriasis: a clinical and epidemiological study of 104 cases. Br J Dermatol1968;80:771–93.
2.
PrystowskiJCohenP. Pustular and erythrodermic psoriasis. Dermatol Clin1995;13:757–70.
3.
LebwohlM. Psoriasis. Lancet2003;361:1197–204.
4.
ElewskiBE. Infliximab for the treatment of severe pustular psoriasis. J Am Acad Dermatol2002;47:796–7.
5.
NewlandMRWeinnsteinA. Kerdel F. Rapid response to infliximab in severe pustular psoriasis, von Zumbusch type. Int J Dermatol2002;41:449–52.
6.
BarlandC. Addition of low-dose methotrexate to infliximab in the treatment of a patient with severe, recalcitrant pustular psoriasis. Arch Dermatol2003;139:949–50.
7.
BenoitSToksoyABrockerEB. Treatment of recalcitrant pustular psoriasis with infliximab: effective reduction of chemokine expression. Br J Dermatol2004;150:1009–12.
8.
SchmickKGrabbeJ. Recalcitrant generalized pustular psoriasis: rapid and lasting therapeutic response to antitumor necrosis factor-α antibody (infliximab), Br J Dermatol, 2004;150:367.
9.
LisbySGniadeckiR. Infliximab (remicade) for acute, severe pustular and erythrodermic psoriasis. Acta Derm Venerol2004;86:247–8.
10.
TrentJKerdelF. Successful treatment of von Zumbusch pustular psoriasis with infliximab. J Cutan Med Surg2004;8:224–8.
11.
CauhariURomanoPMulcahyLD. Efficacy and safety of infliximab montherapy for plaque-type psoriasis: a randomised trial. Lancet2001;357:1842–7.
SeishimaMSeishimaMTakemuraM. Increased serum soluble Fas, tumor necrosis factor α and interleukin 6 concentrations in generalized pustular psoriasis. Dermatology1998;196:371–2.
14.
BaertFNomanMVermeireS. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease. N Engl J Med2003;348:601–8.
15.
HanauerSFeaganBLichtensteinG. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet2002;359:1541–9.
16.
KirbyBMarslandACarmichaelA. Successful treatment of severe recalcitrant psoriasis with combination infliximab and methotrexate. Clinc Exp Dermatol2001;26:27–9.
17.
GoedkoopAKraanMPicavetD. Deactivation of endothelium and reduction in angiogenesis in psoriatic skin and synovium by low dose infliximab therapy in combination with stable methotrexate therapy: a prospective single-center study. Arthritis Res Ther2004;6:R326–34.
18.
MainiRBreedveldFKaldenJ. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor α monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum1998;41:1552–63.
19.
LipskyPvan der HeijdeDSt. ClairEW. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med2000;343:1594–602.
20.
BensGLaharieDBeylot-BarryM. Successful treatment with infliximab and methotrexate of pyostomatitis vegetans associated with Crohn's disease. Br J Dermatol2003;149:181–4.
21.
SchroderOBlumensteinISchulte-BockholtA. Combining infliximab and methotrexate in fistulizing Crohn's disease resistant or intolerant to azathioprine. Aliment Pharmacol Ther2004;19:295–301.
22.
MenterAFeldmanSWeinsteinG. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol2007;56:31.e1–e15.
23.
WassermanMWeberDSuthrieJ. Infusion-related reactions to infliximab in patients with rheumatoid arthritis in a clinical practice setting: relationship to dose, antihistamine pretreatment and infusion number. J Rheumatol2004;31:1912–7.
24.
LequerréTVittecoqOKlemmerN. Management of infusion reactions to infliximab in patients with rheumatoid arthritis or spondyloarthritis: experience from a immunotherapy unit of rheumatology. J Rheumatol2006;33:1–8.
25.
SchwabMKlotzU. Pharmacokinetic considerations in the treatment of inflammatory bowel disease. Clin Pharmacokinet2001;40:723–51.
26.
KramerNChuzhinYKaufmanL. Methotrexate pneumonitis after initiation of infliximab therapy for rheumatoid arthritis. Arthritis Rheum2002;47:670–1.
27.
TrueDPenmetchaMPeckhamS. Disseminated cryptococcal infection in rheumatoid arthritis treated with methotrexate and infliximab. J Rheumatol2002;29:1561–3.
28.
CourtneyPAlderdiceJWhiteheadE. Comment on methotrexate pneumonitis after initiation of infliximab therapy for rheumatoid arthritis. Arthritis Rheum2003;49:617.
29.
OstuniPBotsiosCPunziL. Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate. Ann Rheum Dis2003;62:686–7.
30.
van der KloosterJBosmanROudemans-van StraatenH. Disseminated tuberculosis, pulmonary aspergillosis and cutaneous herpes simplex infection in a patient with infliximab and methotrexate. Intensive Care Med2003;29:2327–9.
31.
ThonhoferRGauggMKriessmayrM. Spontaneous remission of marginal zone B cell lymphoma in a patient with seropositive rheumatoid arthritis after discontinuation of infliximab-methotrexate treatment. Ann Rheum Dis2005;64:1098–9.
32.
VilleneuveESt-PierreAHaraouiB. Interstitial pneumonitis associated with infliximab therapy. J Rheumatol2006;33:1189–93.
