Background Tumour necrosis factor a (TNF a), a proinflammatory cytokine, is considered to be one of the important mediators in the pathogenesis of psoriasis and psoriatic arthritis (PsA) and may therefore be a useful target for specific immunotherapy. Treatment of rheumatoid arthritis with TNF inhibitors has proven to be extremely effective, so the aim of our study was to evaluate the efficacy and safety of multiple infusions with a humanised anti-tumour necrosis factor a monoclonal antibody (infliximab) in PsA and Psoriasis.
Methods Over a period of 22 weeks, nine consecutive patients (5 men, 4 women, mean age 57.3 years, mean duration of PsA/Psoriasis 17.2/18.1 years) who had both active psoriasis and PsA and fulfilled diagnostic criteria were included in this study. Treatment resistant patients with active disease received infusions of 3 mg/kg infliximab (at week 0, 2, 6 14, and 22). The primary endpoints included the changes from baseline to week 22 in the swollen and tender joint count and the improvements of the psoriasis activity (Pasi).
Results The treatment was well tolerated, only one mild side effect was noted. Significant improvements were observed after 2 weeks in the decrease of swollen and tender joint count, which fell from a median of 5.3 and 17.88 at study entry to a median of 1.44 and 9.77 by week 2 (p = 0.02/p = 0.002) and maintained up to week 22. Over the treatment period of twenty two weeks the mean Pasi changed statistically significant from 19.04 to 4.39 (p = 0.002). The improvements of the main parameters are summarised in Table 1.
Conclusion Multiple infusions of infliximab were effective and well tolerated in patients with active psoriasis and PsA. The results provide a good evidence that specific cytokine blockade can be effective in inflammatory disease and offers patients with PsA and psoriasis a new direction of treatment.