Infliximab Combined With Methotrexate as Long-term Treatment for Erythrodermic Psoriasis

Treatment of erythrodermic psoriasis: From the medical board of the National Psoriasis Foundation

“…After his infection was cleared, infliximab therapy was resumed without further complication. 29 It is unclear whether the infection occurred as a result of this patient's underlying disease or whether the treatment regimen contributed. Patients treated with methotrexate and infliximab may have a lower rate of development of anti-chimeric antibodies as well.…”

“…Finally, There are promising case reports suggesting that the combination of infliximab and methotrexate for erythrodermic psoriasis may be efficacious and well tolerated. 20,29 One patient treated with the combination of infliximab and methotrexate developed severe staphylococcal skin infection requiring hospitalization for sepsis and an erythrodermic flare. After his infection was cleared, infliximab therapy was resumed without further complication.…”

Erythrodermic Psoriasis: Current and Future Role of Biologicals

“…An excellent/good response was reported in 53 patients, while failure or moderate response were described for ten subjects [1,[32][33][34]. Combinations of methotrexate with other drugs, including etretinate (one case) [35], cyclosporine (two cases, as outlined above) [28], etanercept (one case) [36], and infliximab (six cases) [23,37,38], have been used in EP with excellent results in all patients except one treated with infliximab and methotrexate who developed staphylococcal sepsis and erythrodermic flare during therapy [37]. Although methotrexate is reported as quite well tolerated in the treatment of EP [1,[32][33][34], caution is required in its use because of the significant susceptibility of EP patients to pneumonitis and hematologic/metabolic complications [1,3,4,8], all potential side effects of this drug [8].…”

“…Infliximab is the most frequently used biological agent in the treatment of EP, with a total of 53 reported instances [20,23,37,38,[40][41][42][43][44][45]. It was administered as a secondline biological therapy in only three cases (after the failure of etanercept in one patient [42] and of an unknown agent in the other two subjects [20]), while the remaining patients were naive to biological drugs.…”

“…Infliximab has also been administered in combination with other classical medications, including acitretin and methotrexate in four and six instances [23,37,38], respectively, with excellent results and no significant side effects in all patients except one (see discussion on conventional therapies).…”