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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Online ISSN 1827-1820
Vena G. A. 1, Cassano N. 1, Loconsole F. 1, Malara G. 2, Sciarrone C. 2, Puglisi Guerra A. 2
1 Department of Internal Medicine Immunology and Infectious Diseases 2nd Dermatology Clinic, University of Bari, Bari, Italy
2 Division of Dermatology, Papardo Hospital, Messina, Italy
Aim. The efficacy and tolerability of a sequential treatment consisting of infliximab followed by cyclosporin A (CsA) was evaluated in patients with severe psoriasis, resistant to conventional therapies, including CsA.
Methods. Patients suffered from chronic plaque psoriasis with psoriasis activity and severity index (PASI) ≥ 16, who had failed to respond to standard treatments and to CsA 3-5 mg/kg/day, received intravenous infliximab 5 mg/kg at day 0 and at week (W) 2. From W2 they were treated with CsA 3 mg/kg/day up to W24. Apart the days devoted to infliximab treatment, subsequent visits were scheduled at W6, W12 and W24, assessing PASI and collecting information on tolerability.
Results. Ten patients, with a baseline PASI of 22.25 (range: 16-29.4), received and completed the study treatment. The mean reduction of PASI was 56% at W2 and 82% at W6. At W6 all patients achieved a PASI-50 response and 7 of them a PASI-75 response. The sequential monotherapy with CsA sustained the clinical response in most cases, with a constant PASI-50 response in 9 out of 10 patients (PASI-75 in 6 patients at W12 and 5 patients at W24). The mean improvement of PASI as compared with baseline was 75% at W12 and 63% at W24. Treatment regimen was well tolerated and no serious adverse events were observed.
Conclusion. The results of this preliminary prospective open-labelled experience suggest that treatment with only 2 infliximab infusions caused a striking improvement of psoriasis, which can be sustained by the sequential use of CsA 3 mg/kg/day in patients who had failed to respond to CsA ≥3 mg/kg/day. It can not be ruled out that infliximab can help to restore the clinical response to conventional treatments previously found as ineffective.