Serum Protein Profile Changes in Psoriatic Patients Undergoing Treatment With Infliximab

February 2016 | Volume 15 | Issue 2 | Original Article | 134 | Copyright © February 2016


Andrea Chiricozzi MD,a Francesca Specchio MD,b Annunziata Dattola MD,b Monika Fida MD,c
Luca Bianchi MD,b and Sergio Chimenti MD,b
and Rosita Saraceno MDb

a Dermatology Department, University of Pisa, Pisa, Italy.
bDermatology Department, University of Rome Tor Vergata, Rome, Italy
cFaculty of Medicine, University of Tirana, Tirana, Albania

Abstract
The therapeutic paradigm in psoriasis includes antitumor necrosis alpha agents that have been proved effective and safe as long-term therapy. Recently, it has been described a correlation between the use of biologic agents and the occurrence of monoclonal gammopathies, which are haematological conditions characterized by clonal plasma cells proliferation producing a monoclonal immunoglobulin that accumulates in the blood.
OBJECTIVE: The aim of this study is to detect electrophoretic abnormalities in psoriatic patients undergoing treatment with infliximab.
RESEARCH DESIGN AND METHODS: A retrospective study evaluating all charts from the clinic database of all patients treated with infliximab. The evaluation of serum protein profile is routinely performed in the clinical setting during biologic therapies. We reported the occurrence MGUS in infliximab-treated patients.
RESULTS: The study analysis included 141 charts. Overall, 23 patients showed a MGUS in their electrophoretic profile, though in 6 cases MGUS was detected at the baseline. Thereby, 17 cases (12.06% of the study population) developed MGUS during infliximab therapy.
CONCLUSIONS: Serum protein electrophoresis test represents a useful tool to detect and monitor any potentially harmful condition that could occur during treatment with a biologic agent. Particularly, it could be crucial for the detection of MGUS, which does not affect clinical response, and it does not represent a criteria to withdraw the treatment.

J Drugs Dermatol. 2016;15(2):134-138.

INTRODUCTION

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations, affecting approximately 2- 3% of the worldwide population.1
Disease severity, evaluated by various assessment tools including PASI, BSA, and PGA, drives the therapeutic algorithm as guidelines usually suggest topical medications and phototherapy for mild or mild-to-moderate psoriasis, while for moderate-to-severe or severe psoriasis systemic conventional therapies are prescribed and they include methotrexate (MTX), cyclosporine A (CyA), PUVA, fumarates, acitretin, and biologics.2
Current understanding of the pathophysiology has led to very encouraging developments for the treatment of this disease. The identification of key-mediators, such as tumour necrosis alpha (TNF-α), involved in psoriasis pathogenesis as selective drugable targets, profoundly changed the history of this disorder. These therapeutics are used whether conventional systemic therapies are contraindicated or ineffective. The TNF-α inhibitors, namely adalimumab, etanercept, and infliximab are significantly efficacious in the treatment of both plaque psoriasis and psoriatic arthritis.3-5 Because they do not cause organ toxicity, they may be used as long-term therapy.6,7 Among them, infliximab, which is a human/mouse chimeric anti-TNF-alpha antibody, has been demonstrated effective in ameliorating both psoriatic skin lesions and joint involvement.8
Clinical response induced by TNF-alpha blockade correlates with the reduction of inflammatory biomarkers such as C-reactive protein (CRP) and serum matrix proteinase.9
Although infliximab shows a favourable safety profile, diagnostic blood and imaging tests are mandatory and recommended before starting and during treatment in order to rule out any infection, metabolic or bloodstream alteration, and malignant tumor.10
Protein electrophoresis is part of the blood test panel used to evaluate any eventual change in the serum protein profile. Alterations such as monoclonal gammopathy of undetermined significance (MGUS) may be detected in patients undergoing treatment with biologic agents.11-14 In accordance with previous
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