Clinical experience of combination therapy of infliximab and total glucosides of paeony for severe psoriasis with liver disorder history

Yu Hu, Lin Lin, Pangen Cui, Xu Yao, Chao Luan, Zhimin Hao, Min Chen

Abstract


Severe psoriasis patients are reported to have a higher risk of liver abnormalities. Treatment option for severe psoriasis patients with liver disorder history remains a great challenge. Hepatic toxicity and long-term safety are the major concerns. Hence it is necessary to look for safer and more effective treatment for those patients. This retrospective review evaluated the safety and efficacy of combination therapy of infliximab and total glucosides of paeony (TGP) in treating 13 severe psoriasis patients with liver disorder history. Patients with severe psoriasis, comprising eight men and five women with a mean age of 37.3 ± 12.3, were observed. The patients experienced a mean course of psoriasis of 11.2 ± 7.1 years. The mean psoriasis area and severity index (PASI) score was 29.3 ± 12.9. All patients have the history of liver disorder. In our study, these patients were treated with infliximab at a dose of 5 mg/kg and TGP at a dose of 1.8 g/day. No liver test abnormalities were seen during combination therapy. After treatment, 61.5% patients showed PASI 50 response at week 2, and 81.8% patients have PASI 75 response at week 6. The mean time for achieving PASI 75 and PASI 90 improvement was 4.2 weeks and 9.6 weeks, respectively. Our observation demonstrates that combined therapy of infliximab and TGP is effective and safe in the treatment of severe psoriasis, especially for patients with liver disorder history.


Keywords


psoriasis; infliximab; total glucosides of paeony; liver disorder; treatment

Full Text:

PDF

References


Gladman DD. Clinical features and diagnostic considerations in psoriatic arthritis. Rheum Dis Clin North Am 2015; 41(4): 569–579. doi: 10.1016/j.rdc.2015.07.003.

Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med 2009; 122(12): 1–9. doi: 10.1016/j.amjmed.2009.06.021.

Finet A, Viguier M, Chazouillères O, et al. Liver test abnormalities in patients admitted for severe psoriasis: Prevalence and associated risk factors. J Eur Acad Dermatol Venereol 2016; 30(10): 1742–1748. doi: 10.1111/jdv.13674.

Tula E, Ergun T, Seckin D, et al. Psoriasis and the liver: Problems, causes and course. Australas J Dermatol 2016. doi: 10.1111/ajd.12460.

Viganò M, Degasperi E, Aghemo A, et al. Anti-TNF drugs in patients with hepatitis B or C virus infection: Safety and clinical management. Expert Opin Biol Ther 2012; 12(2): 193–207. doi: 10.1517/14712598.2012.646986.

Moustou AE, Matekovits A, Dessinioti C, et al. Cutaneous side effects of anti-tumor necrosis factor biologic therapy: A clinical review. J Am Acad Dermatol 2009; 61(3): 486–504. doi: 10.1016/j.jaad.2008.10.060.

French JB, Bonacini M, Ghabril M, et al. Hepatotoxicity associated with the use of anti-TNF-alpha agents. Drug Saf 2016; 39(3): 199–208. doi: 10.1007/s40264-015-0366-9.

Ghabril M, Bonkovsky HL, Kum C, et al. Liver injury from tumor necrosis factor-alpha antagonists: Analysis of thirty-four cases. Clin Gastroenterol Hepatol 2013; 11(5): 558–564.e3. doi: 10.1016/j.cgh.2012.12.025.

Min WQ, Wei Q, Li H, et al. (Mandarin) [A clinical study of total glucosides paeony in the treatment of rheumatoid arthritis: A multi-center trial]. Chinese Journal of Rheumatology 2005; 9(8): 487–491.

Xiang N, Li XM, Zhang MJ, et al. Total glucosides of paeony can reduce the hepatotoxicity caused by Methotrexate and Leflunomide combination treatment of active rheumatoid arthritis. Int Immunopharmacol 2015; 28(1): 802–807. doi: 10.1016/j.intimp.2015.08.008.

Yu C, Fan X, Li Z, et al. Efficacy and safety of total glucosides of paeony combined with acitretin in the treatment of moderate-to-severe plaque psoriasis: A double-blind, randomised, placebo-controlled trial. Eur J Dermatol 2017; 27(2): 150–154. doi: 10.1684/ejd.2016.2946.

Carlin CS, Feldman SR, Krueger JG, et al. A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol 2004; 50(6): 859–866. doi: 10.1016/j.jaad.2003.09.014.

Kalb R, Strober B, Weinstein GM, et al. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 2009; 60(5): 824–837. doi: 10.1016/j.jaad.2008.11.906.

Zachariae H. Dangers of methotrexate/etretinate combination therapy. Lancet 1987; 1(8582): 422.

Saurat JH, Stingl G, Dubertret L, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol 2008; 158(3): 558–566. doi: 10.1111/j.1365-2133.2007.08315.x.

Wang H, Wei W, Wang NP, et al. Effects of total glucosides of peony on immunological hepatic fibrosis in rats. World J Gastroenterol 2005; 11(14): 2124–2129. doi: 10.3748/wjg.v11.i14.2124.

Qin Y, Tian YP. Protective effects of total glucosides of paeony and the underlying mechanisms in carbon tetrachloride-induced experimental liver injury. Arch Med Sci 2011; 7(4): 604–612. doi: 10.5114/aoms.2011.24129.

Chaudhari U, Romano P, Mulcahy LD, et al. Efficacy and safety of infliximab monotherapy for plaque-type psoriasis: A randomised trial. Lancet 2001; 357(9271): 1842–1847. doi: 10.1016/S0140-6736(00)04954-0.

Shear NH, Hartmann M, Toledo-Bahena M, et al. Long-term efficacy and safety of infliximab maintenance therapy in patients with plaque-type psoriasis in real-world practice. Br J Dermatol 2014; 171(3): 631–641. doi: 10.1111/bjd.13004.

Barker J, Hoffmann M, Wozel G, et al. Efficacy and safety of infliximab vs. methotrexate in patients with moderate-to-severe plaque psoriasis: Results of an open-label, active-controlled, randomized trial (RESTORE1). Br J Dermatol 2011; 165(5): 1109–1117. doi: 10.1111/j.1365-2133.2011.10615.x.

Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2007; 56(1): 31.e1–15. doi: 10.1016/j.jaad.2006.07.017.

Gottlieb AB, Evans R, Li S, et al. Infliximab induction therapy for patients with severe plaque-type psoriasis: A randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 2004; 51(4): 534–542. doi: 10.1016/j.jaad.2004.02.021.

Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre, double-blind trial. Lancet 2005; 366(9494): 1367–1374. doi: 10.1016/S0140-6736(05)67566-6.

Sfikakis PP, Iliopoulos A, Elezoglou A, et al. Psoriasis induced by anti-tumor necrosis factor therapy: A paradoxical adverse reaction. Arthritis Rheum 2005; 52(8): 2513–2518. doi: 10.1002/art.21233.

Grinblat B, Scheinberg M. The enigmatic development of psoriasis and psoriasiform lesions during anti-TNF therapy: A review. Semin Arthritis Rheum 2008; 37(4): 251–255. doi: 10.1016/j.semarthrit.2007.05.004.

de Gannes GC, Ghoreishi M, Pope J, et al. Psoriasis and pustular dermatitis triggered by TNF-{alpha} inhibitors in patients with rheumatologic conditions. Arch Dermatol 2007; 143(2): 223–231. doi: 0.1001/archderm.143.2.223.

Afzali A, Wheat CL, Hu JK, et al. The association of psoriasiform rash with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease: A single academic center case series. J Crohns Colitis 2014; 8(6): 480–488. doi: 10.1016/j.crohns.2013.10.013.

Zhou Z, Lin J, Huo R, et al. Total glucosides of paeony attenuated functional maturation of dendritic cells via blocking TLR4/5 signaling in vivo. Int Immunopharmacol 2012; 14(3): 275–282. doi: 10.1016/j.intimp.2012.07.012.

Lin J, Xiao L, Ouyang G, et al. Total glucosides of paeony inhibits Th1/Th17 cells via decreasing dendritic cells activation in rheumatoid arthritis. Cell Immunol 2012; 280(2): 156–163. doi: 10.1016/j.cellimm.2012.12.005.




DOI: http://dx.doi.org/10.24294/ti.v1.i2.42

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 Yu Hu, Lin Lin, Pangen Cui, Xu Yao, Chao Luan, Zhimin Hao, Min Chen

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.