Sustained Efficacy and Safety of Infliximab in Psoriasis: A Retrospective Study of 73 Patients
March 2006 | Volume 5 | Issue 3 | Original Article | 251 | Copyright © March 2006
Richard A. Krathen MD, Cindy N. Berthelot MD, Sylvia Hsu MD
Background: Infliximab inhibits T-cell activation by binding tumor necrosis factor-? (TNF-?). This medication is widely
used in the US for treatment of psoriasis as an off-label indication. The durability of its effect is largely unknown.
Objective: To assess the proportion of patients still on infliximab 12 months after initiation of therapy for psoriasis.
Methods: Retrospective chart review analysis of 73 patients with psoriasis treated with infliximab for at least 12 months
or those who experienced treatment failure in less than 12 months. The point where infusions were deemed to no longer be
efficacious was determined by physicians global assessment (PGA).
Results: Of 73 patients who started infliximab at least 12 months prior to this chart review, 22 (30.1%) had discontinued
treatment secondary to loss of efficacy. Thirty seven patients (50.7%) had no loss of efficacy and continued to receive
infusions. Two patients (2.7%) discontinued due to loss of efficacy after greater than 12 months. Of the 22 patients who
discontinued treatment due to loss of efficacy, 2 were on concomitant methotrexate (5-7.5 mg/wk) therapy. Of the 37
patients still receiving treatment with no loss of efficacy at 12 months, 3 patients were on concomitant methotrexate
therapy. Five patients (6.8%) discontinued secondary to minor adverse events: sinus infection (1), acne (1), fever (1),
arthralgia (1), and transient rash (1). Three patients (4.1%) discontinued due to major adverse events: reactivation of
tuberculosis (1), breast cancer (1), and gastrointestinal bleeding (1). One patient discontinued infliximab secondary to
concerns of possible lymphoma risk (though there were no signs of symptoms of disease on examination), and 3 patients
discontinued due to insurance concerns.
Conclusion: Infliximab treatment resulted in significant improvement in psoriasis, with 37 out of 73 patients (50.7%) experiencing
no loss of efficacy. This longitudinal retrospective chart review demonstrates continued benefit of infliximab infusions in about half of parients after 1 year, though a notable percentag (30.1%) experienced loss of efficacy as determined by physicians global assessement (PGA) and a number of others discontinued due to adverse events or insurance difficulty.