M. Abikhair, M.S. Goh, A.H. Chong, R. Kelly,H. Saunders, P. Foley, C. Baker
Introduction:Infliximab, a chimeric monoclonal antibody
against TNF alpha, is efficacious in multiple dermatological
conditions.
However the high cost of this medication and
a lack of randomised controlled trials limit its accessibility.
Currently on the Australian PBS funding system, infliximab
is indicated for severe chronic plaque psoriasis only.
Method: A retrospective clinical audit was performed,
identifying 22 patients at our institution who received
Infliximab for a non-PBS dermatological condition between
2004 and 2014. The most common indication for infliximab
was severe, recalcitrant hidradenitis suppurativa (12
patients), followed by severe pyoderma gangrenosum (7),
with three other conditions also identified. Completion of
pre-treatment screening and objective scoring measures
were reviewed.
Results: All patients with hidradenitis suppurativa demonstrated
improvement from baseline, with 75% having a
documented life-changing response. Of the 7 patients with
pyoderma gangrenosum, 6 demonstrated significant
improvement permitting weaning of concurrent immunosuppression.
Over half either completely healed or proceeded
to surgical grafting. The mortality rate in our
pyoderma cohort was consistent with previously published
data and was attributable to advanced age and significant
co-morbid illness.
Conclusion: Our results support the benefit of this high
cost medication in a cohort of severe and treatmentresistant
patients.