Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial
- T N Brooklyn1,
- M G S Dunnill1,
- A Shetty2,
- J J Bowden3,
- J D L Williams3,
- C E M Griffiths3,
- A Forbes2,
- R Greenwood1,
- C S Probert1
- 1Bristol Royal Infirmary, Bristol, UK
- 2St Marks Hospital, Harrow, UK
- 3The Dermatology Centre, Hope Hospital, The University of Manchester, Manchester, UK
- Correspondence to:
Dr C S Probert
Bristol Royal Infirmary, Bristol BS2 8HW, UK;
- Accepted 21 September 2005
- Revised 21 September 2005
- Published Online First 27 September 2005
Background: Pyoderma gangrenosum (PG) is a chronic ulcerating skin condition that often occurs in association with inflammatory bowel disease. There have been a number of reports of PG responding to infliximab, a monoclonal antibody against tumour necrosis factor α.
Aim: In the first randomised placebo controlled trial of any drug for the treatment of PG, we have studied the role of infliximab in this disorder.
Subjects: Patients 18 years of age or older with a clinical diagnosis of PG were invited to take part.
Methods: Patients were randomised to receive an infusion of infliximab at 5 mg/kg or placebo at week 0. Patients were then assessed at week 2 and non-responders were offered open labelled infliximab. The primary end point was clinical improvement at week 2, with secondary end points being remission and improvement at week 6.
Results: Thirty patients were entered into the study. After randomisation, 13 patients received infliximab and 17 patients received placebo. At week 2, significantly more patients in the infliximab group had improved (46% (6/13)) compared with the placebo group (6% (1/17); p = 0.025). Overall, 29 patients received infliximab with 69% (20/29) demonstrating a beneficial clinical response. Remission rate at week 6 was 21% (6/29). There was no response in 31% (9/29) of patients.
Conclusions: This study has demonstrated that infliximab at a dose of 5 mg/kg is superior to placebo in the treatment of PG. Open label treatment with infliximab also produced promising results. Infliximab treatment should be considered in patients with PG.
- PG, pyoderma gangrenosum
- IBD, inflammatory bowel disease
- TNF-α, tumour necrosis factor α
- DLQI, dermatology life quality index
Published online first 27 September 2005
This study was supported by a grant from Schering-Plough Ltd. This was an investigator instigated study and the company played no role in study design; collection, analysis, or interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.
Conflict of interest: None declared.