Infliximab efficacy expands: TNF-alpha inhibitors effective in managing PG, HS

November 1, 2008

Some research has demonstrated efficacy with the off-label use of tumor necrosis factor-alpha in treating inflammatory skin conditions such as pyoderma gangrenosum and hidradenitis suppurativa. The use of infliximab, in particular, has resulted in disease quiescence in patients who had either condition, and its use has demonstrated a steroid-sparing effect in patients with pyoderma gangrenosum.

Key Points

Montreal - Infliximab, a chimeric monoclonal antibody, may have therapeutic value in treating some dermatological conditions that are resistant to conventional treatments, says Aaron Drucker, B.A., a medical student at Queen's University School of Medicine in Kingston, Ontario.

Mr. Drucker says tumor necrosis factor (TNF)-alpha inhibitors are approved for use in the management of plaque psoriasis, but that some research has supported that TNF-alpha antagonists may also be effective in managing other inflammatory conditions, such as pyoderma gangrenosum (PG), which often occurs in conjunction with inflammatory bowel disease and hidradenitis suppurativa (HS).

A study published in the British Journal of Dermatology found that infusion with infliximab therapy led to significant decreases in patients' self-reported disease activity scores and physician-observed clinical improvement.

Infliximab therapy

A retrospective chart review examined the impact of infliximab therapy on five patients with PG and four patients with HS. All patients were refractory to previous therapies.

"All of these patients had their disease for quite some time, and they had failed various therapies," Mr. Drucker tells Dermatology Times, noting infliximab is being used in an off-label fashion to treat both PG and HS.

The treatment led to one patient with HS having quiescence of disease for two years after administration of two infusions, and another patient achieved quiescence of disease after four infusions.

A total of two of the three female patients with HS had concomitant polycystic ovary syndrome (PCOS), with both patients demonstrating disease quiescence after treatment.

Mr. Drucker says some published research has pointed to a relationship between HS and PCOS.

Notably, a study published last year in the Journal of Cutaneous Medicine and Surgery examined the prevalence of PCOS in patients with HS, based on HS being linked to a hyperandrogen state.

The study found a 38 percent prevalence of PCOS based on identified androgen markers in 21 patients, and it suggested that hormonal manipulation may be one treatment direction in women who present with HS.

Patients in this retrospective study who presented with PG had a history of using corticosteroids and other immunosuppressive agents. Patients with PG also suffered from comorbidities such as ulcerative colitis, Mr. Drucker says.

Patients were started at a dosage of 5 mg/kg of infliximab. The mean number of infusions was 16. Complete healing occurred in two patients, and two other patients continue to heal.

"All five patients showed some improvement, but a fifth patient had a disease flare-up after a fourth infusion," Mr. Drucker says.

"When that happened, infliximab therapy was discontinued," he says.

Dependence on corticosteroids

The use of infliximab reduced dependence on corticosteroid therapy in this study.

"Infliximab appears to have a steroid-sparing effect," Mr. Drucker says.

"Four patients had been on 20 mg per day of prednisone before starting on infliximab. Three patients had tapered their dose (to 2 mg or less per day) after six months of infliximab therapy," he says.

Infliximab was well-tolerated, with only minor infusion reactions experienced by the patients.

The results suggest infliximab may be promising in these conditions, especially if patients have severe disease and are refractory to current therapies. However, "Prospective, randomized studies are needed to confirm our findings," Mr. Drucker says.

Disclosure: Mr. Drucker reports no relevant financial disclosures.

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