Evaluation of efficacy of infliximab in the long-term treatment of moderate and severe psoriasis vulgaris

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Objective To evaluate the efficacy of long-term treatment with infliximab in patients with moderate to severe psoriasis vulgaris. Methods Patients with moderate to severe psoriasis vulgaris, who started infliximab therapy in Department of Dermatology, Peking University Third Hospital between March 2016 and May 2018, were followed up. The patients treated with infliximab for more than 54 weeks were enrolled into this study. The patients were treated with infliximab at a weight-based dosage of 5 mg/kg, and the total dosage used per session was 200, 300 and 400 mg for patients with the body weight of 40 - 59 kg, 60 - 79 kg, and > 80 kg respectively. The patients were treated at week 0, 2, 6, 14, 22, 30, 38, 46 and 54, and the psoriasis area and severity index (PASI) score was determined before each treatment. Mauchly′s test of sphericity, randomized block analysis of variance and Bonferroni method were used to analyze changes of PASI scores after 2-, 6-, 14-, 22-, 30-, 38-, 46- and 54-week treatment. Sequelae and adverse reactions were also recorded. Results Twelve patients received the treatment with infliximab, and 9 patients were treated for more than 54 weeks, whose clinical data were analyzed. Before the treatment, the PASI score (M[P25, P75]) of the 9 patients was 26.3 (23.4, 27.7) . There were significant differences in the PASI score among different time points (F = 7.12, P = 0.0004) , and the PASI score of the patients showed a generally decreasing trend over time. After 30-week treatment, the PASI score was 4 (2.5, 5.2) , and the PASI improvement rate was 86.38% ± 6.98%; of the 9 patients, 8 achieved PASI50, 7 achieved PASI75, and 2 achieved PASI90. After 54-week treatment, the PASI score was 8 (3.5, 8.9) , the PASI improvement rate was 64.23% ± 17.32%, and the number of patients achieving PASI50, PASI75 and PASI90 was 8, 4 and 1 respectively. Bonferroni method showed that the PASI score significantly increased at week 54 compared with that at week 30 (t = 3.269, P = 0.0048) , but significantly decreased at weeks 30 and 54 compared with that before the treatment (week 30: t = 18.49, P < 0.0001; week 54: t = 5.81, P = 0.0004) . Conclusion Infliximab is remarkably effective for moderate and severe psoriasis vulgaris in the 54- week treatment. Key words: Psoriasis; Biological agents; Treatment outcome; Infliximab; Long-term treatment