In the Journals

Infliximab dose escalation optimized durability in psoriasis, psoriatic arthritis patients

Patients with psoriasis optimized the durability of infliximab treatment by dose escalation and further maintained response probability with concomitant methotrexate, according to recent study results.

Researchers in New York conducted a retrospective study of 93 patients with moderate to severe psoriasis (mean age, 50.2 years; 48.4% women) treated with infliximab. Fifty-nine patients (63.4%) also had psoriatic arthritis. Fifteen patients (16.1%) received concurrent methotrexate therapy.

Patients received a median infliximab dose of 5.42 mg/kg/month (range, 2.71-10.83 mg/kg/month) for a mean of 28 months (216.3 patient-years). Sixty-two patients (66.7%) received a dose escalation.

Therapy duration was extended by concurrent methotrexate for a mean of 19.5 ± 8.1 months (P=.034), which included time until first dose escalation (mean, 12 ± 6.1 months; P=.037) and failure (mean, 20.7 ± 6.7 months; P=.034).

“Patients who increased the infusion frequency before increasing the dose remained on infliximab 8.4 months longer than those who first increased the dose (P=.045),” the researchers reported.

Four patients, including two with upper respiratory infections, experienced adverse events; two patients discontinued therapy.

“Methotrexate extends the usefulness of infliximab, which can be critical for those patients for whom infliximab remains their only option,” the researchers concluded. “We encourage the use of combination methotrexate and infliximab in certain psoriatic patients, particularly those who have failed multiple previous systemic medications, as this regimen significantly improves the probability of maintaining clinical response.

“Our substantial experience with infliximab doses and interval frequencies that are higher than those recommended in the package insert provides support for the therapeutic use and safe practice of dose escalation in treating moderate to severe psoriasis with or without psoriatic arthritis.”

Disclosure: See the study for a full list of relevant financial disclosures.