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

Abstract

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.

Psoríase moderada a grave tratada com infliximabe em 53 pacientes: perfil dos pacientes, eficácia e efeitos adversos

“…There may be a direct relationship between the increase in proinflammatory cytokine synthesis due to activation of the Th1-type cytokines such as TNF-alpha, for example, found in the physiopathogenesis of psoriasis and of comorbidi-ties such as obesity, 22,23 arterial hypertension, insulin resistance, dyslipidemia and spondyloarthropathies. 20,10 Since these associations are common, it is therefore also possible to understand the increased risk of cardiovascular disease in these patients, a risk that is particularly associated with younger patients and those with more severe psoriasis.…”

“…not immune reactions. 23 The increases in blood pressure were treated with 25 mg of captopril, while the other symptoms were resolved by reducing the velocity of the infusion. 17 One effect observed during infusion that has not been reported in the literature was very intense renal colic in one patient, which did not improve when the velocity of the infusion was reduced.…”

“…1 Obesity is one of the most prevalent comorbidities and may be directly related to the severity of the skin condition, since visceral fat is known to be a potential source of TNF-alpha synthesis. [22][23][24] The negative effect of psoriasis on patients' quality of life should also be taken into consideration, since it leads to social reclusion and changes in eating habits, consequently resulting in weight gain. 25,26 Patients with psoriasis who are overweight are at an increased risk of diabetes and hypertension, and have a significantly elevated atherogenic lipoprotein profile.…”

Development of lupus erythematosus during infliximab treatment

“…A TNF-α-gátlók az egyik legújabb, a DILE hátterében leírt gyógyszercsoport. Az ANA-és a dsDNS-ellenes antitestek képződése álta-lánosan megfi gyelt jelenség [23,24,25,26]. Az egyes gyógyszereket vizsgálva az ANA-emelkedés inkább az infl iximabra jellemző, az etanerceptre kevésbé [27].…”

“…A kezelés során esetlegesen perzisztáló kóros autoantitest-titerek egyes szerzők szerint a terápia hatékonyságára nézve rossz előjelnek tekinthetőek. Psoriasisos és Beçhet-kórban szenvedő betegek biológiai terápiája kapcsán megfigyelték, hogy az emelkedett ANA-titer a kezelés csök-kent hatásosságával korrelál [24,47,48]. Újabban felvetődik speciális markerek használatának lehetősége a biológiai terápia várható eredményességének becslé-sére.…”