Kling Maxwell C, Larian Amir A, Scordi-Bello Irini, Emer Jason, Lebwohl Mark G
Department of Dermatology, Mount Sinai School of Medicine, 5 E 98th St, Fifth Floor, New York, NY 10029, USA.
Arch Dermatol. 2010 Jun;146(6):651-4. doi: 10.1001/archdermatol.2010.96.
The use of biologic agents represents a remarkable advance for patients with psoriasis and psoriatic arthritis who have experienced an incomplete response to other therapeutic modalities. Decreased mortality and improved quality of life have been reported in patients undergoing treatment with these agents. Increased risk of bacterial, viral, granulomatous, and opportunistic infections also has been associated with the use of these medications. Enhanced patient education, watchful monitoring to promote early detection of infections, discontinuation of the medication when clinical symptoms are identified, and immediate availability of supportive care are advised to balance the benefit of treatment with biologic agents against the potential risk of infection. Herein, we discuss the risk of infection and the monitoring and vaccination guidelines in patients having psoriasis treated with biologic agents.
A woman with obesity and psoriasis that had previously been successfully treated with efalizumab (Raptiva) for 3 years was started on a regimen of infliximab (Remicade) to treat a flare. She died 1 week after her first infusion of infliximab and was found to have had influenza A(H1N1).
We report the first case to date of a patient with psoriasis who died of influenza A(H1N1) respiratory tract infection while undergoing treatment with infliximab. Further observations are needed to make a causal association.
对于对其他治疗方式反应不完全的银屑病和银屑病关节炎患者，生物制剂的使用是一项显著进展。据报道，接受这些药物治疗的患者死亡率降低，生活质量提高。使用这些药物还与细菌、病毒、肉芽肿和机会性感染风险增加有关。建议加强患者教育，密切监测以促进感染的早期发现，在识别出临床症状时停用药物，并立即提供支持性护理，以平衡生物制剂治疗的益处与潜在感染风险。在此，我们讨论接受生物制剂治疗的银屑病患者的感染风险以及监测和疫苗接种指南。
一名肥胖且患有银屑病的女性，此前曾成功使用依法利珠单抗（ Raptiva）治疗3年，现开始使用英夫利昔单抗（Remicade）治疗病情发作。她在首次输注英夫利昔单抗1周后死亡，尸检发现患有甲型H1N1流感。
我们报告了首例接受英夫利昔单抗治疗的银屑病患者死于甲型H1N1流感呼吸道感染的病例。需要进一步观察以确定因果关系。
