EXPERIENCE OF THE LONG-TERM USE OF ANTICYTOKINE THERAPY IN PSORIASIS

Abstract

Increasing the effectiveness of treatment and restoring the quality of life in patients with moderate to severe and severe forms of psoriasis is one of the most important trends in modern dermatology. The appearance of biological products in the late XXth century opened new opportunities in the treatment and control of the course of the disease in patients suffering from moderate and severe forms of psoriasis. Conducting maintenance system treatment with biological products reduces the severity of course of dermatosis, and in some cases prevents the occurrence of disease relapses. Despite the increasing popularity of anti-cytokine drugs, there are difficulties in the treatment of choice of the therapy in some cases. Among the main reasons for the lack of response to ongoing biological therapy are the genetic characteristics of the patient and the immunogenicity of the drugs. Failures in the use of biological therapy can also result a low concentration of the drug before the next administered dose. It has been proven that the combined use of methotrexate and infliximab inhibits the development of anti-drug antibodies that are associated with the development of a low therapeutic response. The article describes the clinical observation of a patient suffering for 20 years from a severe form of psoriasis and psoriatic arthritis. The experience of long-term (about 10 years) prescription of the biological preparation infliximab with sufficient clinical response without additional use of methotrexate is shown. The results of successful combined therapy of psoriatic erythroderma and psoriatic arthritis with infliximab and acitretin in order to reduce the immunogenicity of the tumor necrosis factor α blocker and avoid the ”escape” effect are described. The data of restoration of a good therapeutic response to systemic biological therapy with infliximab after administration of acitretin are presented.

Keywords

psoriasis / anticytokine therapy / infliximab / ”escape” effect / systemic therapy

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