The study, with a small sample size, said most patients who take infliximab for more than 6 years report continued efficacy.
Infliximab can be safe and effective as a long-term therapy in people with psoriasis, according to a new long-term study.
The research, published in the journal Dermatology Research and Practice, is the first to look at drug efficacy and survival over a time horizon longer than 5 years. The therapy has been approved for the treatment of psoriasis since 2005.
A team including corresponding author François Aubin, MD, PhD, of the University of Franche-Comté, in France, wanted to gain a better understanding of the experiences of patients who take the drug for 6 or more years. They noted that very little long-term research had been done into the drug.
The investigators set up a multicenter retrospective study, asking members of the psoriasis group of the French Society of Dermatology to report on patients who had been taking the drug for at least 6 years. Demographic data, comorbidities, body mass index, and adverse events, among other data, were noted.
Altogether, the study included 43 patients who were on infliximab for a median of 8.5 years, dating back to between 2005 and 2012. As of May 2018, 70% of the enrollees continued to take the drug, with doses at 4-6 mg/kg every 8 to 10 weeks, and an efficiency of about 100%, Aubin and colleagues reported. Five patients were still taking the drug, but at higher doses of 6 and 10 mg/kg; one patient had methotrexate added to the therapy.
Among the 13 patients who stopped treatment with infliximab, the most common reason (6 patients) was loss of efficacy. Another 3 patients developed solid tumor cancer. Two patients requested to switch to other subcutaneous biologics. One patient developed an infusion reaction after 6 years, while another patient was lost to follow-up.
Though most of the patients in the study continued to successfully take the therapy, Aubin and colleagues noted that they were the exception when compared to the entirety of patients prescribed infliximab. Previous studies have suggested drug survival for infliximab is less than 20% at 6 years, and in this study Aubin and colleagues calculated 14% drug survival rate at 6 years.
Patients who used the drug over the long term had notable prevalences of certain other conditions. The majority (72%) were overweight, including 30% who were obese. Dyslipidemia was found in 35% of patients, and depressive disorders were diagnosed in 30% of patients.
“Our long-term data suggest the critical role of weight-based dosing for IFX which may be considered as the ideal TNF blocker to treat obese patients,” Aubin and colleagues wrote.
As for the risk of cancer, Aubin and his team noted that the number of patients with cancer in their study was small, which aligns with other studies of infliximab. That’s not cause for alarm, Aubin and colleagues write, though it is something investigators and clinicians should note.
“Although it was difficult to attribute these cancers to the long-term use of [infliximab], our data suggest that long-term pharmacovigilance is still required,” they wrote.
In conclusion, Aubin and colleagues said while the drug is not a fit for all—or even most–patients with psoriasis, it appears to be a good long-term option for a minority of patients.
“In conclusion, our study demonstrates the long term sustained benefit of [infliximab] in a small proportion of psoriasis patients, particularly in obese patients,” they write.
Carlet C, Bichard D, Richard MA, et al. Long-term infliximab treatment in psoriasis patients: A national multicentre retrospective study. Dermatol Res Pract. 2020;2020:1-3. doi:10.1155/2020/2042636.