Infliximab Treatment for Psoriatic Arthritis

Dosing and Administration

The American Academy of Dermatology and National Psoriasis Foundation (AAD-NPF) guidelines strongly recommend infliximab as a monotherapy treatment option for adults with psoriatic arthritis (Strength of recommendation A) 1

The drug is also recommended as a monotherapy option in patients with plaque psoriasis of any severity when associated with significant psoriatic arthritis (Strength of recommendation A) 1
Common adverse events include infusion reactions, risk of serious infections, and potential development of antibodies to infliximab 2
Regular monitoring should include periodic history and physical examination, with consideration of yearly tuberculosis testing and periodic complete blood count and liver function tests 2

Methotrexate may be considered as comedication in certain clinical circumstances to improve efficacy or reduce the development of antibodies to infliximab (Strength of recommendation D) 3
For patients who have an incomplete response to standard dosing, the AAD-NPF guidelines indicate that infliximab may be administered at more frequent intervals and/or at higher doses up to 10mg/kg for better disease control (Strength of recommendation B) 4
Interrupted therapy should be avoided due to the associated increased risk of infusion reactions and poorer disease control 3

The American Academy of Dermatology recommends infliximab may be administered at more frequent intervals and/or at higher doses up to 10mg/kg for better disease control in adult patients, with a strength of recommendation B 5
The European League Against Rheumatism (EULAR) guidelines recommend achieving low disease activity as the treatment target, which the patient has achieved on the current regimen 6
The patient's current dose of 7mg/kg every 6 weeks is medically necessary, given clinical indicators such as pre-infusion symptom breakthrough and severe disease with multiple treatment failures 5, 7
Approximately 39% of patients lose efficacy with standard maintenance dosing, supporting the need for individualized dose optimization 8
Intensive laboratory monitoring every 12 weeks and regular clinical assessments every 6 months are appropriately documented in the treatment plan 5, 6
The American Academy of Dermatology states that "dose and interval of infusions may be adjusted as needed" 9, 8
TNF inhibitors, including infliximab, are recommended with Level A evidence for moderate to severe peripheral arthritis and skin disease 10, 7