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Treatment of palmoplantar psoriasis with infliximab: a randomized, double-blind placebo-controlled study

Authors


  • The trial is registered at ClinicalTrials.gov, number NCT00629772.

  • Conflicts of interest
    Dr Bissonnette has been a speaker, consultant, investigator and/or advisory board member for Abbott Laboratories, Amgen-Wyeth, Astellas Pharma, Centocor, Janssen Ortho, Novartis and Schering-Plough. He has received compensation in the form of grants and/or honoraria from these companies. No conflicts of interest exist.

    Dr Poulin has been a speaker, consultant, investigator and/or advisory board member for Abbott Laboratories, Amgen-Wyeth, Astellas Pharma, Centocor, Ortho Biotech, EMD Serono and Schering-Plough. He has received compensation in the form of grants and/or honoraria from these companies. No conflicts of interest exist.

    Dr Guenther has been a speaker, consultant, investigator and advisory board member for Abbott Laboratories, Amgen-Wyeth, Astellas Pharma, Centocor, Janssen Ortho, Novartis and Schering Plough and Schering-Plough Canada. She has received compensation in the form of grants and/or honoraria from these companies. No conflicts of interest exist.

    Dr Lynde has been a speaker, consultant, investigator and/or advisory board member for Abbott Laboratories, Amgen-Wyeth, Astellas Pharma, Centocor, Janssen Ortho and Schering-Plough. He has received compensation in the form of grants and/or honoraria from these companies. No conflicts of interest exist.

    Dr Bolduc has been a speaker, consultant, investigator or advisory board member for, Abbott Laboratories, Amgen-Wyeth, Biogen, Celgene, Centocor, Galderma, Genentech, Leo Pharma, Medimmune, Novartis and Schering-Plough Canada. She has received compensation in the form of honoraria from these companies. No conflicts of interest exist.

    Dr Nigen has been a speaker, consultant, investigator and/or advisory board member for Abbott Laboratories, Amgen-Wyeth, Astellas Pharma, Centocor, Janssen Ortho, Novartis and Schering-Plough Canada. He has received compensation in the form of honoraria from these companies. No conflicts of interest exist.

    This article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal and has not been published previously.

  • Funding sources
    This study was funded by an investigator grant from Schering-Plough Canada, Inc.

R. Bissonnette. E-mail:rbissonnette@innovaderm.ca

Abstract

Background  Palmoplantar psoriasis is a difficult to treat variant of plaque psoriasis.

Objective  To study the safety and efficacy of infliximab in non-pustular palmoplantar psoriasis.

Methods  Patients with non-pustular palmoplantar psoriasis affecting at least 10% of their palms and soles and with a modified palmoplantar psoriasis area and severity index (m-PPPASI) of at least eight were recruited. Patients were randomized (1:1) to receive infliximab 5 mg/kg or placebo at weeks 0, 2 and 6. Patients initially randomized to placebo received infliximab at weeks 14, 16 and 20 whereas patients randomized to infliximab received additional infliximab infusions every 8 weeks until week 22.

Results  Twenty four (24) patients were randomized in this study. At week 14, 33.3% and 66.7% of patients treated with infliximab achieved m-PPPASI 75 and m-PPPASI 50 respectively compared to 8.3% for both m-PPPASI 75 (P = 0.317) and m-PPPASI 50 (P = 0.009) for patients randomized to placebo. A reduction of 50.3% in the mean surface area of palms and soles affected with psoriasis was seen at week 14 in patients randomized to infliximab as compared to an increase of 14.9% in patients randomized to placebo (P = 0.009).

Conclusions  This pilot study did not reach its primary endpoint of m-PPPASI 75 at week 14. However, infliximab was observed to be more efficacious than placebo in improving PPSA and with respect to the percentage of patients reaching m-PPPASI 50 at week 14. Larger and longer term studies are needed for severe patients to better assess the efficacy of infliximab in palmoplantar psoriasis.

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