Infliximab then efalizumab, the 'hit and run' approach does not work

In a previous paper we described 2 patients treated with a sequential biologic therapy for chronic plaque psoriasis. We used infliximab as an induction treatment followed by efalizumab. We extended this approach to 3 other patients.

The purpose was to show the feasibility of a sequential approach with biologicals.

Five patients received three infusions of infliximab followed by weekly injections of efalizumab from week 10 on.

The most important findings, summarized in a table, show that none of the patients continued the treatment for more than a year either because of non-responsiveness or because of spontaneous stopping. Moreover, 4 out of 5 patients did not respond or had serious adverse events on reintroduction of infliximab.

Overall, we cannot recommend sequential therapy using infliximab and efalizumab.