Infliximab
Remicade® Infliximab IFX
MSD
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
Lyophilisate
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 each infusion
Before each infusion
i.v.
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
Dry substance
systemic