Remicade® Infliximab IFX
Chimereric monoclonal IgG1 antibody, binds soluble and membrane-bound TNF-α
Plaque psoriasis in adults, in ETA, IFX, ADA, UST, SEC and IXE also psoriatic arthritis, in ETA: indicated from 6 years of age
Yes (Infliximab: in case of failure of a previous TNF inhibitor therapy)
Treatment of adult patients with severe psoriasis (Def. in USZ and Swiss S1 Guideline): PASI > 10 or BSA > 10 and/or DLQI > 10) in which UVB and PUVA or one of the following three systemic rapias (Ciclosporin, Methotrexate, Acitretin) have shown no therapeutic success. In iximab, additional failure of another TNF blocker approved for psoriasis
Blood count, liver enzymes, creatinine, U status, pregnancy test in urine, CRP/ ESR. Screening for HBV, HCV, HIV and tuberculosis including Rx thorax. Optional: ANA, HLA-Cw6 (personalized medicine as not yet validated response predictor for Ustekinumab)
Blood count, CRP, liver transaminases, creatinine, possibly β-HCG
Before every infusion
Before every infusion
5 mg/kg in weeks 0, 2, 6. Then every 8 weeks. Combination with MTX may prolong drug survival
1 - 4 weeks
Week 10: 75 - 80 % Week 24: 69.2 %
Week 10: 49.5 % Week 24: 50.6 %
19'941.60 (29'912.40) (5 mg/kg for 80kg person)
Not recommended
PASI, (use PrecisePASI for greater accuracy once PASI < 10), DLQI after 10 and 24 weeks
19.5 - 51.5 %, association with clinical response
Absolute contraindications: Heart disease NYHA III-IV, active infections, live vaccinations, malignant tumors in the last 5 years, except treated epithelial tumors or cervical dysplasia, demyelinating diseases, unclear neurological conditions (including family history). Pregnancy and breastfeeding. Active HBV/Tbc infection. Relative contraindications: systemic lupus erythematosus. In IFX: Allergies to murine antibodies.
Up to 8 % mild infusion reactions. Viral and bacterial infections including reactions to opportunistic infections, fever, serum disease, autoantibodies, lupus-like syn- drome, cytopenia, headaches, vertigo, exacerbation of demyelinating diseases, flush, gastrointestinal complaints, elevated liver values, spinocellular carcinomas, drug exanthema, pruritus, paradoxical psoriasis.
Yes, with simultaneous HBV therapy (start 3 months before anti-TNF therapy). HBV DNA and liver function every 2 months, together with gastroenterology. Best evidence with Etanercept
Yes, monitoring of liver function and HCV-RNA, therapy together with gastroenterology. Best evidence with Etanercept.
Possible, case-dependent decision, together with infectiology
Anakinra, Abatacept
Cancer risk is slightly increased for skin cancers, but not other tumors