Infliximab for psoriasis

What is infliximab?

Infliximab belongs to the class of biological response modifiers called tumor necrosis factor blockers (TNF). The brand name of the original drug is Remicade®. Generic infliximab biosimilars are also commercially available and under development (including Remsima ™, Inflectra ™, Infliximab BS "NK").

What is infliximab used for?

Infliximab is currently approved in adults and children over 6 years of age for the treatment of psoriasis and psoriasis. arthritisas well as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, and ulcers colitis.

In one major study, infliximab very quickly and effectively controlled psoriasis and, in about half of the patients, stopped disease progression after just 3 doses of the drug.

Experimentally, infliximab has been shown to help some patients with other serious illnesses. inflammatory skin conditions such as hidradenitis suppurativa, pyoderma gangrenous and pemphigus vulgaris.

How does infliximab work?

Infliximab is biologically engineered from humans and mice antibody molecules. It works by directly binding to tumor necrosis factor (TNF) in the blood and diseased tissue. TNF bound to infliximab cannot bind to or activate TNF receptors, which are involved in the development of psoriasis plates.

How is infliximab given?

Infliximab is given by intravenous infusion over 2 hours in a specialized center. Patients receiving infliximab require close supervision and monitoring throughout treatment. It repeats after 2 and 6 weeks. If effective, the treatment can be repeated every 8 weeks.

Patients receiving infliximab are also often prescribed methotrexate, which helps prevent the formation of anti-infliximab. antibodies.

Contraindications infliximab

Infliximab should not be used in the following circumstances.

• No treatment chronic infection, such as tuberculosis or viruses hepatitis B or C
• Patients with moderate to severe congestive heart failure.
• Known hypersensitivity to murine proteins or any other component of the product

Precautions while taking infliximab

Caution should be exercised when considering the use of infliximab in patients prone to infections or in those with chronic or recurrent infections

• Patients should be tested for tuberculosis (TB), viral hepatitis B / C, and human immunodeficiency virus (HIV) before starting infliximab.
• Treatment should be stopped if a severe infection occurs, for example, requiring hospitalization or intravenous antibiotics. It can often be restarted once the infection has been effectively treated.
• Uncommon infections with organisms such as listeria and legionella can be more common and more serious in patients with infliximab.

Infliximab should also be used with caution in the following situations:

• Mild congestive heart failure
• Pre-existing central nervous system (CNS) disorders, p. convulsions
• Elderly patients
• Patients with kidney or liver failure.
• During pregnancy and breastfeeding

Patients requiring major surgery may be advised to temporarily discontinue infliximab approximately 4 weeks prior to a planned operation. It can be started again 2 weeks after surgery, as long as there is no infection present.

Vaccines and infliximab

Immunization status should be checked before starting infliximab. If necessary, vaccinations should be updated before treatment. Annual flu vaccination is recommended.

As they can induce disease in immunocompromised individuals, live vaccines should not be used during treatment with infliximab. Currently available live attenuated viral vaccines include measles, mumps, rubella, chickenpox, yellow fever, influenza (intranasal vaccine) and oral polio vaccine. Attenuated life bacterial Vaccines include BCG and the oral typhoid vaccine.

Read more about immunization at immunosuppressed dermatology patients

What are the side effects of infliximab?

Infliximab is well tolerated in most people. If any of the following symptoms are severe or do not go away, you should contact your doctor.

• Cough
• Nausea and / or vomiting
• Stomach ache
• Headache
• Fever and night sweats
• Fatigue and muscle weakness.
• Unexpected weight loss

Acute Infusion-related reactions include difficulty breathing or swallowing, chest pain, swelling of the face, lips or hands, dizziness and headache, redness, urticariaand burning at the IV infusion site. These can be treated by reducing the infusion rate and with paracetamol and antihistamines.

In a small number of patients, symptoms and signs similar to lupus may appear. These include photosensitivity and joint and muscle pain (arthritis and arthralgia) Treatment should be stopped if this occurs.

Serious cutaneous reactions have rarely been reported, including Stevens-Johnson syndrome and toxic epidermal necrolysis Some patients have been reported to develop dermatitis, chronic license plate psoriasis and palmoplantar pustulosis.

Like all medicines that work on the immune system, infliximab can increase the risk of certain types of lymphoma. They have rarely been reported in patients on infliximab, usually those also taking other medications that suppress the immune system, such as azathioprine or mercaptopurine. Skin cancers, in particular scaly cell carcinoma, have also been reported in patients with infliximab. These patients generally have other risk factors, such as severe sun damage or prior photochemotherapy (PUVA) treatment.

Monitoring while on infliximab

Regular follow-up visits to monitor security and effectiveness treatment are necessary. It is recommended that patients taking biologic medications have routine blood tests every 6 months or so, including complete blood count and liver function tests. TB tests should be repeated from time to time.