Infliximab versus methotrexate, etanercept, adalimumab, and ustekinumab for plaque psoriasis

According to large-scale population studies conducted in the United Kingdom in 2006, psoriasis affects 1.5% of individuals and if these prevalence rates are apply to the Canadian population, more than 500,000 Canadians could be diagnosed with psoriasis. The most common clinical form of psoriasis is plaque psoriasis, encompassing approximately 80% of psoriasis patients. There are a variety of management options for psoriasis, but no permanent cure. Mild-to-moderate forms of psoriasis are treated with topical therapy and phototherapy, while moderate-to-severe forms (PASI score ?10) require systemic or biologic therapy. These therapies include: the disease-modifying anti-rheumatic drug, methotrexate; the tumor necrosis factor-alpha (TNF-[alpha]) blockers, adalimumab, etanercept, and infliximab; and the inhibitor of interleukin (IL)-12 and IL-23, ustekinumab. Infliximab has been recommended for the treatment of adults with very severe plaque psoriasis that have failed to respond to standard therapies such as methotrexate, cyclosporine, or ultraviolet radiation, or are intolerant to these treatments. The purpose of this review is to examine the comparative clinical efficacy, safety, and cost-effectiveness of infliximab versus methotrexate, etanercept, adalimumab, or ustekinumab for the treatment of adults with plaque psoriasis.