Liana Suciu 1, Carmen Cristescu 1, Mirela Voicu 1, Maria Suciu 1, B. Bumbăcilă 1
1 University of Medicine and Pharmacy Timisoara, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy
Abstract
Psoriasis arthritis is a seronegative chronic inflammatory arthropathy, which occurs in patients with psoriasis and is accompanied by characteristic symptoms. Shortcomings of conventional therapy, frequent and sometimes severe side effects induced by classical immunomodulatory substances (methotrexate, cyclosporine, leflunomide), lack of ethyo-pathogenic theories has been leading to research on new therapeutic perspectives in psoriasis, including for psoriasis arthropathy. Pathogenesis of psoriasis has highlighted a number of changes related to keratinocytes, T lymphocytes, dermal fibroblasts and a number of genes encoding several types of proteins involved in proliferation of keratinocytes. The aim of the present study was to highlight the effectiveness of therapy with biological agents (infliximab and etanercept), assessed by improvement of PASI score, and to assess the incidence of adverse effects detected in patients during the study group. Patients enrolled in the study were selected by eligibility criteria and the final number was 14, from which eight patients were treated with infliximab and six were treated with etanercept in Dermatology Clinic from Timisoara. In the infliximab – treated group to whom the drug was administered iv 5mg/kgc for two hours at weeks 0, 2, 6 and 8 weeks thereafter until week 24, a rate of 62.5% of cases showed a 75% improvement in index PASI, in 12 weeks . Evaluation performed at week 24 showed improvement of symptoms (objective by index steps) to 87.5% of patients, thus proving efficacy. Administration over 24 weeks resulted in adverse effects: myalgia and fever in 32% of patients, the increase of transaminases in 25% of patients. No patient treated with infliximab did not show de novo appearance of antibodies antiADN DC. The group of patients treated with Etanercept, administered in doses 25mg/twice a week, for 24 weeks, were obtained the following results: after 12 weeks of treatment PASI index improved to 50% of cases, after 24 weeks the percentage of patients which occurred improvement was 66.66. Adverse effects in this group were represented by: transient leukopenia and thrombocytopenia (one case), autoimmune events (one case) and local reactions as redness and induration at the site of administration, delivered spontaneously (two patients). This study has shown considerable clinical effects in psoriasis arthropathy, but it is not considered a first-line therapy because of the incidence of adverse events which has to be monitored and interpreted in the context of each patient’s clinical condition on such therapy and not least because of the extremely high cost of the treatment.