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Derm News: 2007.4(6)

A follow-up study in 28 patients treated with infliximab for severe recalcitrant psoriasis: evidence for efficacy and high incidence of biological autoimmunity.

British Journal of Dermatology 156 (2), 329-336.
N. Poulalhon, E. Begon, C. Lebbé, F. Lioté, M. Lahfa, D. Bengoufa, P. Morel, L. Dubertret, H. Bachelez

Background

Infliximab, an antitumour necrosis factor-a chimeric monoclonal antibody, is effective for the treatment of severe psoriasis. While the induction of antinuclear antibodies (ANA) and antidouble-stranded-DNA antibodies (anti-dsDNA-ab) is frequently observed in patients with rheumatoid arthritis and Crohn disease receiving infliximab, the incidence of induced biological and clinical autoimmunity remains unknown in the context of psoriasis.

Objectives

To investigate biological and clinical signs of autoimmunity in 28 patients receiving infliximab for severe, recalcitrant forms of psoriasis, and the clinical response to treatment.

Methods

Twenty-eight patients, 15 men and 13 women (median age 39ˇ4 years) with psoriasis refractory to three or more systemic treatments were included. Twenty presented with plaque-type psoriasis [median Psoriasis Area and Severity Index (PASI) score 25ˇ9; range 7ˇ2-48], five with psoriatic erythroderma (median PASI score 54; range 48-72) and three with generalized pustular psoriasis (GPP). Psoriatic arthritis was present in 13 patients (46ˇ4%). Infliximab 5 mg kg 1 was given at week (W) 0, W2, W6 and every 8 weeks thereafter. Clinical data were assessed at baseline and before each infusion. Detection of ANA and of IgM and IgG anti-dsDNA-ab were performed at baseline and at W22 by immunofluorescence and enzyme-linked immunosorbent assay, respectively.

Results

The mean number of infliximab infusions was 5ˇ5 (range 2-15). Among patients with plaque-type and erythrodermic psoriasis, 17 of 25 (68%) and three of five reached a PASI improvement of 75% or more, respectively, while rapid improvement of clinical and biological signs was observed in all three patients with GPP. The prevalence of positive detection of ANA raised from 12% at baseline to 72% at W22 (P = 0ˇ0001), an increase which was also observed for IgM anti-dsDNA-ab (68% vs. 0%, P < 0ˇ0001), while no significant change was observed for the IgG isotype (16% vs. 0%, P = 0ˇ125). Three patients developed nonerosive polyarthritis, without any other criteria for systemic lupus.

Conclusions

The incidence of biological autoimmunity is high in patients with refractory psoriasis receiving infliximab. The concomitant onset of polyarthritis in three cases raises the need to investigate the incidence of autoimmune manifestations in psoriatic patients receiving infliximab in further large-scale studies.


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The Derm News service provided by the Editorial Consultants of Skin Therapy Letter© and its founding editor Dr. Stuart Maddin.