Sequential Use of Infliximab and Etanercept in Generalized Pustular Psoriasis

Generalized pustular psoriasis is a dramatic potentially life-threatening psoriasis variant and represents a major therapeutic challenge. Tumor necrosis factor α (TNF-α) inhibitors have been shown to be highly effective in psoriasis vulgaris and psoriasis arthritis. Currently, TNF-α can be targeted therapeutically by 2 different approaches. TNF-a antibodies show a fast onset of action and a long-lasting activity. Soluble TNF-α receptors have a slower onset and a shorter duration of activity, which allows a rapid cessation of the drug's activity in the case of adverse events. Here we report that a remission of generalized pustular psoriasis achieved by the TNF-α antibody infliximab was maintained by long-term application of the soluble TNF-α receptor etanercept. Sequential therapy with TNF-α antibodies and TNF-α receptors may represent a novel concept that combines a rapid onset of action in the initiation therapy with a lower risk for severe adverse events in the maintenance treatment of pustular psoriasis.