Off-label Uses and Side Effects of Infliximab

Infliximab was first approved by the FDA in 1998 as a treatment of moderately-to-severely active Crohn’s disease in patients who have an inadequate response to conventional therapies, and fistulizing Crohn’s disease. In November 1999 the FDA approved it for use in rheumatoid arthritis with methotrexate, and further expanded this indication in December 2000. It appears to be a promising agent in the treatment of a variety of inflammatory diseases, psoriasis in particular. A MEDLINE search was performed for “infliximab” in February of 2004, and the 1,116 articles found were reviewed. Approximately 200 articles were identified that contained references to the treatment with infliximab of skin disease, off-label uses, systemic diseases with cutaneous manifestations, and systemic and cutaneous side effects. These articles were reviewed and their contents summarized. Infliximab has been proven in well-controlled trial trials to ameliorate inflammatory bowel disease, rheumatoid arthritis, psoriasis, psoriatic arthritis, and ankylosing spondylitis. Anecdotal reports report it useful in treating the cutaneous manifestations and associations of inflammatory bowel disease, Behçet’s disease, graft versus host disease, Sjogren’s syndrome, refractory sarcoidosis, and a variety of other conditions. Its notable side effects include an increased risk of the induction of infections (e.g., tuberculosis). Infliximab is a very promising medication in the treatment of inflammatory dermatological conditions and should be used in larger scale trials of more diseases.