FDA approved to
What’s involved in
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
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.
Studies conducted to obtain approval from the U.S. Food and Drug
Administration (FDA) have found:
Often rapid skin
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.
therapy more effective.
Research shows that continuous therapy proves more effective than
as-needed therapy for maintaining results.
Drop in skin
Over time, some patients may lose a bit of clearing, dropping from
75% or greater clearing to about 60%.
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
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.
results in sustained improvements.
continue receiving infliximab on a regular basis, they maintain
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.
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.
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
Woolacott NF et al. “Etanercept
and infliximab for the treatment of psoriatic arthritis: a
systematic review.” Clinical and Experimental Rheumatology.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.