Recombinant human tumor necrosis factor receptor II: IgG Fc fusion protein for the treatment of erythrodermic psoriasis: a clinical observation

Objective To evaluate the efficacy of recombinant human tumor necrosis factor receptor Ⅱ: IgG Fc fusion protein (rhTNFR∶Fc) for the treatment of erythrodermic psoriasis. Methods A total of 23 patients with erythrodermic psoriasis were subcutaneously injected with rhTNFR∶Fc 25 mg (starting dose, 50 mg) twice a week for 12 weeks. Thereafter, they were followed up for 2 years. Outcome measures included the proportion of patients achieving 50%, 75% and 90% reduction in psoriasis area and severity index (PASI50, PASI75 and PASI90) , the serum level of tumor necrosis factor-α (TNF-α) , and incidence of adverse reactions. Statistical analysis was carried out by using nonparametric Friedman test and repeated measures ANOVA with the software SPSS 19.0. Results After 12-week treatment, the PASI score significantly decreased from 57.35 ± 3.45 at the baseline to 5.57 ± 3.60 in the patients with erythrodermic psoriasis (P < 0.01) , with the proportion of patients achieving PASI50, PASI75 and PASI90 being 100% (23 cases) , 95.65% (22 cases) , and 60.87% (14 cases) respectively. The serum level of TNF-α showed a significant decrease from 62.87 ± 15.23 ng/L before the treatment to 4.57 ± 2.99 ng/L (P < 0.01) after 12-week treatment. No adverse reactions were observed during the treatment. After 24-month follow-up, PASI scores experienced no significant changes in these patients compared with those at the end of 12-week treatment, and the number of patients achieving PASI50, PASI75 and PASI90 was 23, 20 and 15 respectively. The serum level of TNF-α was significantly lower at the end of 24-month follow-up than at that of 12-week treatment (3.37 ± 1.62 vs. 4.57 ± 2.99 ng/L, P < 0.05) . Conclusion rhTNFR∶Fc is effective for the control of acute inflammation in erythrodermic psoriasis. Key words: Psoriasis; Tumor necrosis factor-alpha; rhTNFR: Fc; TNF-alpha antagonists