Long-term study of infliximab for psoriasis in daily practice: drug survival depends on combined treatment, obesity and infusion reactions

BACKGROUND

Infiximab has been shown to be highly effective in phase III clinical trials, but limited information is available regarding drug survival and maintenance of efficacy beyond 1 year in real-life clinical setting.

OBJECTIVES

To analyse the efficacy and safety of infliximab in a large number of patients with a long follow-up and to identify clinical factors associated with long-term drug survival.

METHODS

A retrospective review of patients with moderate-to-severe psoriasis treated with infliximab from March 2004 to August 2012 at a tertiary dermatology centre was carried out.

RESULTS

In total, 63 treatment courses with infliximab were administered to 56 patients. The mean duration of treatment was 31.6 months. The only significant positive predictor of drug survival was combination treatment [hazard ratio (HR) vs. monotherapy 2.90, 95% confidence interval (CI) 1.42–5.92]. Significant negative predictors of drug survival were obesity (HR 0.40, 95% CI 0.19–0.87) and infusion reactions (HR 0.40, 95% CI 0.19–0.87). Infusion reactions occurred in 13 (23%) of our patients and were a reason for discontinuation of treatment in 5.

CONCLUSIONS

This retrospective review of a cohort of patients with moderate-to-severe psoriasis treated with infliximab in daily practice shows that the PASI75 response rates at 24 and 52 weeks of treatment are similar to those of the pivotal studies, but 37 courses of treatment (59%) had to be discontinued after a median of 12 months. The major cause for discontinuation was loss of response, in 18 cases. Combination treatment, obesity and infusion reactions were found to be predictors of drug survival.