Efficacy and safety of infliximab monotherapy for plaque-type psoriasis: a randomised trial
U Chaudhari, P Romano, LD Mulcahy, LT Dooley… - The Lancet, 2001 - thelancet.com
U Chaudhari, P Romano, LD Mulcahy, LT Dooley, DG Baker, AB Gottlieb
The Lancet, 2001•thelancet.comBackground Currently available treatments for moderate to severe psoriasis are either
incompletely effective in some patients, or are associated with toxic effects. Since tumour
necrosis factor α (TNF-α) is thought to have a role in the pathogenesis of psoriasis, we did a
double-blind, randomised trial to assess the clinical benefit and safety of infliximab-a
monoclonal antibody against TNF-α. Methods 33 patients with moderate to severe plaque
psoriasis were randomly assigned intravenous placebo (n= 11), infliximab 5 mg/kg (n= 11) …
incompletely effective in some patients, or are associated with toxic effects. Since tumour
necrosis factor α (TNF-α) is thought to have a role in the pathogenesis of psoriasis, we did a
double-blind, randomised trial to assess the clinical benefit and safety of infliximab-a
monoclonal antibody against TNF-α. Methods 33 patients with moderate to severe plaque
psoriasis were randomly assigned intravenous placebo (n= 11), infliximab 5 mg/kg (n= 11) …
Background
Currently available treatments for moderate to severe psoriasis are either incompletely effective in some patients, or are associated with toxic effects. Since tumour necrosis factor α (TNF-α) is thought to have a role in the pathogenesis of psoriasis, we did a double-blind, randomised trial to assess the clinical benefit and safety of infliximab-a monoclonal antibody against TNF-α.
Methods
33 patients with moderate to severe plaque psoriasis were randomly assigned intravenous placebo (n=11), infliximab 5 mg/kg (n=11), or infliximab 10 mg/kg (n=11) at weeks 0, 2, and 6. Patients were assessed at week 10 for the primary endpoint (score on the physician's global assessment [PGA]). Analysis was by intention to treat.
Findings
Of the 33 patients enrolled, three dropped out. Nine of 11 (82%) patients in the infliximab 5 mg/kg group were responders (good, excellent, or clear rating on PGA), compared with two of 11 (18%) in the placebo group (difference 64% [95% CI 20–89], p=0·0089), and ten of 11 (91%) patients in the infliximab 10 mg/kg group were responders (difference from placebo 73% [30-94], p=0·0019). The median time to response was 4 weeks for patients in both infliximab groups. There were no serious adverse events, and infliximab was well tolerated.
Interpretation
In this controlled trial, patients receiving the anti-TNF-α agent infliximab as monotherapy experienced a high degree of clinical benefit and rapid time to response in the treatment of moderate to severe plaque psoriasis compared with patients who received placebo. These findings suggest that TNF-α has a pivotal role in the pathogenesis of psoriasis.
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