Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series

Routhouska, Shannon B.; Sheth, Pranav; Korman, Neil J.

doi:10.2310/7750.2008.07036

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…These include etanercept and cyclosporine, infliximab and methotrexate, and infliximab followed by etanercept. 19,[32][33][34]43,45 Combination therapy allows physicians to maximize benefits and reduce adverse effects associated with various therapies.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

Robinson¹,

Voorhees²,

Hsu³

et al. 2012

Journal of the American Academy of Dermatology

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289

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Section: Discussionmentioning

confidence: 99%

“…[19][20][21][32][33][34][41][42][43] Because of the faster onset of action with infliximab and cyclosporine, many physicians consider these drugs as firstline treatment in patients with severe, acute disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

Robinson¹,

Voorhees²,

Hsu³

et al. 2012

Journal of the American Academy of Dermatology

Self Cite

211

289

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“…Infliximab is highly effective, resulting in 75% clearance of psoriasis (Psoriasis Area and Severity Index (PASI) 75) in .70% patients at 12 weeks [83]. In addition to improving the chronic plaque form of the disease, infliximab has been shown to be of utility in generalised pustular psoriasis in small case series [84], although palmar plantar pustular psoriasis does not appear to respond and may even be precipitated by TNF antagonist therapy [85]. Improvement of nail disease has been demonstrated [86].…”

Section: Psoriasismentioning

confidence: 99%

The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement

et al. 2010

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Anti-tumour necrosis factor (TNF) monoclonal antibodies or soluble TNF receptors have become an invaluable treatment against chronic inflammatory diseases, such as rheumatoid arthritis, inflammatory bowel disease and psoriasis. Individuals who are treated with TNF antagonists are at an increased risk of reactivating latent infections, especially tuberculosis (TB).Following TNF antagonist therapy, the relative risk for TB is increased up to 25 times, depending on the clinical setting and the TNF antagonist used. Interferon-c release assays or, as an alternative in individuals without a history of bacille Calmette-Guérin vaccination, tuberculin skin testing is recommended to screen all adult candidates for TNF antagonist treatment for the presence of latent infection with Mycobacterium tuberculosis.Moreover, paediatric practice suggests concomitant use of both the tuberculin skin test and an interferon-c release assay, as there are insufficient data in children to recommend one test over the other. Consequently, targeted preventive chemotherapy is highly recommended for all individuals with persistent M. tuberculosis-specific immune responses undergoing TNF antagonist therapy as it significantly reduces the risk of progression to TB. This TBNET consensus statement summarises current knowledge and expert opinions and provides evidence-based recommendations to reduce the TB risk among candidates for TNF antagonist therapy.KEYWORDS: Interferon-c release assay, tuberculin skin test, tuberculosis, tumour necrosis factor T umour necrosis factor (TNF) and TNF receptors play a key role in mediating immune responses in acute and chronic inflammation [1][2][3]. Over the past decade, TNF antagonists in the form of anti-TNF monoclonal antibodies or TNF fusion protein have become an invaluable treatment against chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and inflammatory bowel disease [4][5][6][7]. Tuberculosis (TB) is a granulomatous disease caused by infection with Mycobacterium tuberculosis.Most of the individuals who are thought to have become infected with M. tuberculosis will never develop TB due to the control exercised by the host immune system [8,9]. One of the key cytokines in the immune response against infection with M. tuberculosis is TNF, which is also critical for the integrity of the granuloma [10]. Individuals who are being treated with anti-TNF therapies are at increased risk of developing TB. Following TNF antagonist therapy, the relative risk for TB is increased 1.6-25.1 times, depending on the clinical setting and the TNF antagonist used [4,7,11,12]. The majority of cases of TB related to TNF antagonist therapies occur in close temporal proximity to

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“…[49] It is usually administered every 6 weeks in a dose of 5 mg/kg. Routhouska et al [50] reported success with the addition of weekly, low dose methotrexate. This is echoed by the author's experience of two generalized pustular psoriaisis patients who showed remarkable clinical improvement within 48 h of the first infusion and concomitant methotrexate 5 mg/week.…”

Section: Infliximab With Concomitant Methotrexatementioning

confidence: 97%

Infliximab: Efficacy in psoriasis

Arsiwala¹

2013

Indian J Dermatol Venereol Leprol

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Moderate to severe psoriasis often needs to be addressed with standard disease modifying therapies such as methotrexate, cyclosporine, acitretin or ultraviolet radiation, which have their potential benefits and limitations. The tumor necrosis factor-alpha (TNF-α) is elevated in psoriatic plaques compared to non lesional skin as well as in the plasma of patients with moderate to severe psoriasis. Infliximab, a TNF-α blocker, has been recommended for the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to these therapies or who cannot tolerate them. Its specific action on the bound and membrane forms of the pro-inflammatory cytokine TNF-α has made it the molecule of choice for obtaining quicker and longer remission in recalcitrant cases. However, the widespread use of infliximab in the Indian subcontinent is limited by its cost. This article reviews the international guidelines for use of infliximab, its dosage patterns, and efficacy in chronic plaque psoriasis, nail psoriasis, erythrodermic psoriasis, and pustular psoriasis as well as Indian experience.

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Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series

Abstract: Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.

Cited by 19 publications

References 26 publications

Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement

Infliximab: Efficacy in psoriasis

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