This 5-year retrospective analysis is of 22 patients who participated in the product familiarisation program (PFP) at St Vincent's Hospital Melbourne, prior to the listing of
infliximab on the
Pharmaceutical Benefit Scheme. Criteria for inclusion were being an adult with chronic plaque
psoriasis, having a
psoriasis area and severity index (PASI) score of at least 15 with an inadequate response or intolerance to three of the following:
phototherapy,
acitretin,
cyclosporin and
methotrexate. Participants were infused with
infliximab 5 mg/kg on the standard induction (weeks 0, 2 and 6) and maintenance (8-weekly) protocols. At each visit PASI and dermatology life quality index (DLQI) scores were recorded. Success was determined as the proportion of patients achieving at least a 75% improvement in the PASI score from baseline (PASI 75). At 60 months after commencement of
therapy, 31% of patients remained on
infliximab. Those who did retained PASI 75 with a DLQI of 0 or 1. Of those who ceased
infliximab, nine did so due to loss of efficacy, three for personal reasons, two for serious adverse events and one was lost to follow up. Adverse events included non-
melanoma skin cancers,
infections and abnormal liver
enzymes.
Infliximab in the Australian context has proven to be a highly effective treatment of chronic plaque
psoriasis, and patients who remained on the
drug derived a high level of satisfaction, assessed both subjectively (DLQI) and objectively (PASI 75). The variable response indicates that
psoriasis is a heterogeneous disease and investigation into potential patient selection for treatment in the future is warranted.