SATURDAY

October 19

SESSION 3

2:40 – 3:00

Wayne Gulliver

Psoriasis is a T-cell mediated inflammatory disease which has a defined genetic component.  To date, a total of seven susceptibility loci have been mapped (PSORS1 to PSORS7). As these genetic investigations have grown in both scope and technological sophistication, so too have we advanced on the therapeutic level. Current research focuses on T-cell mediation of hyperproliferation, and the function of the skin as an immunological tissue.  Multiple breakthroughs in the treatment of psoriasis, using immune and biological based therapies have been developed.  One particular target is tumor necrosis factor alpha (TNF Alpha).  Of note is the fact that PSORS1 harbors TNF alpha and this is the therapeutic target of both Infliximab (Remicade) and Etanercept (Enbrel).  In a recent study, Infliximab (Remicade) administered at either 5 or 10 mg/kg IV shows significant efficacy in patients treated with 3 infusions at 0, 2 and 6 weeks. By week 10, 82% of the patients treated at 5 mg/kg and 73% of the patients treated at the dose of 10 mg/kg had at least 75% improvement in the PASI four weeks post treatment. This improvement was maintained with the majority of the patients 6 months post treatment. As no dose ranging studies were performed we studied the therapeutic effect of Infliximab infusion at a fixed dose of 200 mg IV per treatment (2 to 3 mg/kg) given at 0, 2 and 6 weeks.  To date we have observed, in some patients, similar results with the lower dose regime.  Low dose Infliximab can induce significant clinical improvement in patients with severe psoriasis. Further dose ranging studies will be necessary to confirm these findings.