Treatment: Biologics
Infliximab

FDA approved to treat:

• Adults with severe plaque psoriasis who are candidates for systemic therapy and for whom other treatments are medically less appropriate.

• Adults with active and progressive psoriatic arthritis.

What’s involved in taking infliximab:

• Patient receives infusions at an infusion center or in a doctor’s office. Given by IV, each infusion takes between 2 and 3 hours. After the first infusion, the patient receives an infusion at 2 weeks, 6 weeks, and then about once every 8 weeks.

• Some patients have received infliximab on an as-needed basis; however, studies show that regular dosing proves more effective.

• Before a patient receives infliximab, the patient is screened for hepatitis B and tuberculosis (TB).

• When a dermatologist prescribes infliximab, the patient is closely monitored and receives regular follow-up exams. 

How infliximab works: Research shows people who have psoriasis and psoriatic arthritis have too much TNF-alpha, a chemical found in the immune system. This excess TNF-alpha causes the immune system to overreact, which leads to the inflammation that produces psoriasis lesions and the inflamed joints of psoriatic arthritis. Infliximab blocks TNF-alpha and helps lower the amount of TNF-alpha in the person’s body. This prevents the inflammation that causes psoriasis and psoriatic arthritis.

Effectiveness: Studies conducted to obtain approval from the U.S. Food and Drug Administration (FDA) have found:

• Often rapid skin clearing. Studies show that psoriasis patients receiving infliximab often experience rapid improvement. During a 50-week study, more than 70% of patients had 75% or greater clearing by week 10. In the first 10 weeks, some of these patients were completely clear.

• Regular infliximab therapy more effective. Research shows that continuous therapy proves more effective than as-needed therapy for maintaining results.

• Drop in skin clearing. Over time, some patients may lose a bit of clearing, dropping from 75% or greater clearing to about 60%.

• Effective for psoriatic nails. When the psoriasis involves the nails, infliximab can be very effective. Patients may experience less crumbling of the nail plate, fewer red dots in the nails, and decreased pitting.

• Can slow or stop joint damage of psoriatic arthritis. Some studies suggest that infliximab can prevent further joint damage. X-rays taken during one study show that patients who have taken infliximab for one year have significantly less joint damage than the patients who did not receive infliximab.

• Continued therapy results in sustained improvements. When patients continue receiving infliximab on a regular basis, they maintain results.

• Effective in patients not helped by other medications for psoriatic arthritis. At week 16, patients treated with infliximab who had not been helped by other medications for psoriatic arthritis had these responses: 65% had a 20% or greater improvement, 46% had 50% or greater improvement, and 29% had 70% or greater improvement.

Safety and side effects: While clinical trials show that infliximab is generally well-tolerated, patients receiving infliximab must be carefully monitored. Serious and sometimes fatal side effects have been reported. Patients have developed TB and other serious infections while receiving infliximab therapy. A rare form of T-cell lymphoma has been reported in patients with Crohn’s disease. There also have been rare reports of liver diseases. Some cases were fatal. Other patients required liver transplants.

In a 50-week study, 12 cases of cancer were reported; ten of these were skin cancers. All of these patients had received phototherapy before beginning infliximab. In another study, patients stopped taking infliximab because they either saw their psoriasis worsen, had difficulty breathing during infusions, or experienced nausea.

Less serious side effects are more frequent, especially when patients are just beginning infliximab. Reports of infusion-site reactions, cough, and inflamed sinuses occur.

References:
Antoni CE et al. “Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT).” Arthritis and Rheumatism. 2005. April;52(4):1227-36.

Gottlieb AB. “Biologics Workshop.” Presented as a workshop (WRK 404) at the 65th Annual Meeting of the American Academy of Dermatology. February 2007; Washington, DC.

Menter A et al. “A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis.” Journal of the American Academy of Dermatology. 2007. January;56(1):31.e1-31.e15.

Woolacott NF et al. “Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review.” Clinical and Experimental Rheumatology. 2006. September-October;24(5):587-93.

 
An educational program brought to you by the American Academy of Dermatology.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.

Supported by an educational donation provided by Amgen and Wyeth.