Anti-TNF-alpha therapy in plaque psoriasis

Targeting the inflammatory process is known to improve outcomes for patients with plaque psoriasis

Plaque psoriasis: continuous therapy may be more effective (Photograph: Dr P Marazzi/SPL)
Plaque psoriasis: continuous therapy may be more effective (Photograph: Dr P Marazzi/SPL)

The RESTORE2 study suggests that maintenance therapy with infliximab every eight weeks has advantages over intermittent treatment given at the point of >50% loss of Psoriasis Area and Severity Index (PASI) improvement.

A total of 222 patients were randomised to receive continuous therapy (infliximab 5mg/kg-1 every eight weeks), and 219 to intermittent therapy (no infliximab until >50% loss of PASI improvement).

Patients in the continuous therapy group had greater PASI 75 at week 52 (81/101, 80%) than the intermittent group (39/83, 47%). More serious infusion-related reactions occurred with intermittent therapy (4% subjects) than with continuous therapy (<1%).

The impact of this study is twofold: first, for patients with moderate to severe plaque psoriasis, continuous therapy with infliximab may be more effective than intermittent therapy. Second, clinicians should consider the risk of adverse effects before proceeding with intermittent infliximab in this group.

Reich K, Wozel G, Zheng H et al. Br J Dermatol 2013; 168: 1325-34

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