2 The technology

2.1 Infliximab (Remicade, Schering-Plough) is indicated for the treatment of moderate to severe plaque psoriasis in adults whose condition has failed to respond to, or who have a contraindication to, or who are intolerant of other systemic therapies including ciclosporin, methotrexate or PUVA.

2.2 The most common adverse events reported during infliximab therapy include acute infusion-related reactions, infections and delayed hypersensitivity reactions. Infliximab is contraindicated in people with moderate or severe heart failure and active infections. Before treatment is initiated, people must be screened for both active and inactive tuberculosis. The summary of product characteristics (SPC) lists a number of uncommon but serious adverse events related to the immunomodulatory activity of infliximab. For full details of side effects and contraindications, see the SPC.

2.3 Infliximab costs £419.62 per 100-mg vial ('British national formulary' [BNF] edition 53). It is given as a 5-mg/kg intravenous infusion over a 2-hour period followed by additional 5-mg/kg infusion doses at 2 and 6 weeks after the first infusion, then every 8 weeks thereafter. The manufacturer estimates the average annual cost per patient to be approximately £11,750. Costs may vary in different settings because of negotiated procurement discounts.