Infliximab (Remicade) in the Treatment of Psoriasis

• Infliximab is a chimeric monoclonal antibody against TNF, with human constant regions and murine variable regions. Studies have shown that it is the most effective biologic agent for the treatment of psoriasis at the usually prescribed doses.
• Since dosing is weight-based (start 0.5 mg/kg on weeks 0, 2, and 6, then 0.5 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 requires discontinuation of the medication. More unusual adverse events include serious infections (including tuberculosis), hepatotoxicity, hematologic suppression, neurologic disease, a lupus-like syndrome, and an increased incidence of malignancy.
• One concern of infliximab is loss of efficacy over periods as short as 6-12 months. A recent study has shown that patients that respond to infliximab but do not maintain this response have a drop in detectable serum infliximab levels at the time of infusion. This can be associated with the formation of antibodies to infliximab. Administration of infliximab with methotrexate may decrease antibody formation. If a patient begins to show a loss of efficacy while on infliximab, the frequency of infusions may be increased.

Kalb. R 2013 (07) – Kalb. R. Treatment of Psoriasis in the Age of Biologics – 25th Annual Scientific Meeting of the Dermatological Society of Singapore (DSS) – Singapore