Systemic Therapy for Psoriasis

Melvin Lee, MD; Robert E. Kalb, MD


Dermatology Nursing. 2008;20(2):105-111. 

In This Article

Infliximab (Remicade®)

Infliximab is a chimeric monoclonal antibody against TNF, with human constant regions and murine variable regions. It is the most effective biologic agent for treating psoriasis at the usually prescribed doses (Menter, Feldman, et al., 2007; Menter, Papp, et al., 2007; Reich et al., 2005). Since dosing is weight based (start 5 mg/kg on weeks 0, 2, and 6, then 5 mg/kg every 8 weeks), it may be given more consideration when treating heavier patients. Infliximab is administered intravenously, and access to an infusion clinic is necessary when starting this medication.

Patients receiving infliximab infusions may develop an infusion reaction which uncommonly re quires discontinuation of the medication (Cheifetz et al., 2003; Leonardi, Guzzo, Reich, &Li, 2007; Wasserman et al., 2004). More unusual adverse events include serious infections (including tuberculosis), hepatotoxicity, hematologic suppression, neurologic disease, a lupus-like syndrome, and an increased incidence of malignancy (Bongartz et al., 2006; Setoguchi et al., 2006).

One concern of infliximab is loss of efficacy over periods as short as 6 to 12 months (Krathen, Berthelot, & Hsu, 2006; Papp, 2006). In a recent study, patients who responded to infliximab but did not maintain this response had a drop in detectable serum infliximab levels at the time of infusion (Bendtzen et al., 2006). This can be associated with the formation of antibodies to infliximab. Administration of infliximab with methotrexate may decrease antibody formation (Bendtzen et al., 2006). If a patient begins to show a loss of efficacy while on infliximab, the frequency of infusions may be increased (Berger, Edelsberg, Li, Maclean, & Oster, 2005).


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