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Infliximab safe 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 with severe pustular psoriasis who presented in 2001 with a significant flare that required hospitalization, infliximab (Remicade) treatment resulted in remarkable clearing (J. Am. Acad. Dermatol. 2002;47:796-7). This year, Dr. Varma reported on the patient's 7-year follow-up.

The patient was first 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. At 4 months after his initial treatment, his skin remained clear and 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 he stopped treatments because of insurance issues and was treated with 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 with infliximab.

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 in at least one other study to be efficacious when given every 8 weeks for plaque psoriases. This case shows 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.

"Infliximab is a great choice for ... pustular psoriasis," he said.
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Title Annotation:Dermatology
Author:Worcester, Sharon
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Aug 1, 2008
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