• M Viguier, C Pagès, F Aubin, E Delaporte, V Descamps, C Lok, M Beylot-Barry, J Séneschal, L Dubertret, J-J Morand, B Dréno, H Bachelez, and Groupe Français de Recherche sur le Psoriasis.
• Sorbonne Paris Cité Université Paris Diderot, Assistance Publique-Hôpitaux de Paris, Service de Dermatologie, Hôpital Saint-Louis, 1 Avenue Claude-Vellefaux, 75475 Paris Cedex 10, France. manuelle.viguier@sls.aphp.fr
• Br. J. Dermatol. 2012 Aug 1; 167 (2): 417-23.

BackgroundEven though efficacy of biologics has been extensively studied in psoriasis vulgaris, studies in erythrodermic psoriasis, the most severe form of the disease, have been scarcely reported.ObjectivesTo address the efficacy and safety of biologics in patients with erythrodermic psoriasis.MethodsA multicentre national retrospective study was performed using the French Psoriasis Group network. Patients showing psoriasis involving at least 90% of body surface area (BSA), and in whom severity of the disease had been evaluated before and after 3 and/or 6 months of treatment with biologics, were enrolled in the study. Results were expressed using intention-to-treat analysis.ResultsWe included 28 patients, representing 42 flares of erythrodermic psoriasis treated with infliximab (n=24), adalimumab (n=7), etanercept (n=6), ustekinumab (n=3) or efalizumab (n=2). A 75% improvement of BSA or Psoriais Area and Severity Index 12-14 weeks after treatment onset was reached in 48% of flares treated with infliximab, in 50% of those treated with adalimumab and in 40% of those treated with etanercept. Twelve serious adverse events, consisting of bacterial infection in seven of them, were observed. Biological treatment was discontinued for safety concern in 19% of cases. A given biologic was administered for up to 48 weeks in 34% of flares.ConclusionsBiologics show overall good short-term efficacy, but treatment switch due to lack of efficacy or side-effects is frequently observed on a longer term, with only one-third of patients still receiving the same drug after 1 year. The most significant safety concern consists of severe infections.© 2012 The Authors. BJD © 2012 British Association of Dermatologists.

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