An international team led by a dermatologist at The University of Manchester has found that treatment with the emerging drug infliximab, marketed as Remicade, can quickly and significantly improve psoriasis symptoms.
The European Infliximab for Psoriasis Efficacy and Safety Study (EXPRESS) was a placebo-controlled trial on 378 patients with moderate to severe psoriasis, to test the efficacy and safety of the drug. The findings, published in the 15 October issue of The Lancet, show that 80% of patients achieved at least a 75% improvement in symptoms after ten weeks treatment with the drug, as opposed to just 3% of those receiving a placebo. Psoriasis is a chronic condition which results when skin cells over-produce and accumulate on the surface of the skin, producing red, scaly ‘plaques’ which may itch and bleed. It is thought to be genetic in origin and is a consequence of an abnormal inflammatory response in the skin. Around 2% of the population suffer from the disease, with about 30% of cases considered moderate to severe, but until now treatment options have been limited. Infliximab blocks the activity of ‘tumour necrosis factor alpha’ (TNF-alpha), a protein involved in inflammation, and the vast majority of the trial subjects treated with the drug achieved clinically-significant levels of skin clearance. Nearly 60% experienced at least a 90% improvement in symptoms – or near-complete skin clearance – after ten weeks, versus 1% receiving the placebo, whilst 26% achieved complete skin clearance (versus 0% receiving the placebo). The improvements continued throughout the 50-week study. Professor Christopher Griffiths, the University academic leading the trial from the Dermatology Centre at Hope Hospital, Salford, said: “These results indicate that Infliximab is a very effective therapy among the newer biological treatments for psoriasis. As a dermatologist, I am very encouraged by the data, which show that patients with moderate to severe psoriasis can rapidly achieve skin clearance and that these results can be maintained.” Patients receiving Infliximab also experienced a good response in nail psoriasis, which is present in 20 – 50% of psoriasis patients and often thought of as a treatment-resistant disease. By week 24 of the trial, those receiving the drug were experiencing a 56% average decrease in this condition, and again this response was maintained throughout the trial. “Physicians’ assessments of the patients’ conditions backed up our findings,” confirmed Professor Griffiths, “with 83% of those receiving the drug assessed as having minimal or cleared symptoms by week 10 of the trial as opposed to just 4% of those receiving the placebo.”(Source: University of Manchester: The Lancet: October 2005.)