Long-term infliximab found effective for pustular psoriasis.

SAN ANTONIO -- Infliximab appears to be a valuable treatment for long-term management of pustular psoriasis, Dr. Rajat Varma said at the annual meeting of the American Academy of Dermatology.

In a patient who had a significant flare of severe pustular psoriasis that required hospitalization, infliximab (Remicade) treatment resulted in remarkable clearing.

The case was reported in 2002 by Dr. Boni E. Elewski (J. Am. Acad. Dermatol. 2002;47:796-7). This year, Dr. Varma reported on the patient's 7-year follow-up.

The patient was rest seen at age 44 years with 90% of his body surface area affected, and he was treated with 5 mg/kg of intravenous infliximab. His pustules cleared within 2 weeks; 1 month after his third infusion, less than 5% of his body surface area was still affected. After 4 months, the joint pain associated with psoriatic arthritis was improved, said Dr. Varma of the University of Alabama at Birmingham.

Over the next 2 years, the patient received 5 mg/kg of intravenous infliximab every 7-8 weeks; this was increased to every 6 weeks to manage a gradual return of his pustular psoriasis. In late 2003, insurance issues caused him to switch to 50 mg of etanercept twice weekly. Significant worsening of his disease occurred within 4 months, which required another hospitalization and reinstitution of infliximab treatment. By his own assessment he was 98% clear after two treatments.

Over the following 2 years he tolerated the treatments well. He had no significant complications or severe infections, so his methotrexate dose was tapered to 10 mg/week and eventually to 5 mg/week. His body surface area remains less than 5% affected; he continues to receive infliximab treatments every 6-7 weeks.

Continuous maintenance with infliximab has been shown to be efficacious when given every 8 weeks for plaque psoriases. This case demonstrates that it is also effective for pustular psoriasis and can safely be used long term, noted Dr. Varma, who reported no conflicts of interest in regard to his case presentation.

BY SHARON WORCESTER

Southeast Bureau