THERAPEUTICS: Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial

• Published in: British journal of dermatology (1951) Vol. 154; no. 6; pp. 1161 - 1168
• Main Authors: Reich, K, Nestle, F O, Papp, K, Ortonne, J-P, Wu, Y, Bala, M, Evans, R, Guzzo, C, Li, S, Dooley, L T, Griffiths, CEM
• Format: Journal Article
• Language: English
• Published: 01.06.2006
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2006.07237.x

Background: Psoriasis has a well-documented, markedly negative effect on patient quality of life. Objectives: To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis. Methods: The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg super(-1) induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen. Results: At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores (P < 0.001) and SF-36 physical and mental component summary scores (P < 0.001) than placebo-treated patients. Significant improvement (P < 0.001) was also seen in all eight SF-36 subscales, and was greatest for the 'Bodily Pain' and 'Social Functioning' scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 (P < 0.001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50. Conclusions: Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement.