Combination Therapy of Biologics With Traditional Agents in Psoriasis

Lyn C. Guenther, MD, FRCPC

Disclosures

Skin Therapy Letter. 2011;16(6) 

In This Article

Combination Therapy With Etanercept (Enbrel®)

Calcipotriol

The addition of calcipotriol cream twice daily for 4 weeks, then once daily for 8 weeks, in patients with psoriasis and psoriatic arthritis who had not achieved PASI 50 at week 12 (n=45 patients) with etanercept 50 mg twice weekly, allowed 31.1% (14 patients) to become PASI 75 responders and 51.1% (23 patients) to become PASI 50 responders at week 24 despite a dose reduction in etanercept to 25 mg twice weekly at week 12.[21]

Phototherapy

Narrowband UVB enhances efficacy irrespective of whether it is used from the start (12 week PASI 75 in 90% vs. 40% on etanercept 25 mg twice weekly monotherapy)[22] or added after 6 weeks to patients who had not attained PASI 75 response with etanercept 50 mg twice weekly (after 6 weeks of combination therapy: mean PASI=1.6 vs. 4.7 for non-UVB treated body half, p=0.0192).

Methotrexate

In the EASE trial, the odds ratio of a 'clear'/'almost clear' PGA was 2.246 (95% confidence interval (CI) 1.25, 4.0; p=0.0069) for concomitant methotrexate/etanercept when compared with etanercept monotherapy.[23] In this study, 30% of patients could reduce their weekly dose of methotrexate and 16% could stop it altogether. In the EDUCATE study, 29% could discontinue methotrexate and 7% could lower their dose.[24] In cases of inadequate response to methotrexate, in one study continuation of the methotrexate when etanercept was initiated resulted in greater efficacy with a similar safety profile than when the methotrexate was tapered and discontinued during the first 4 weeks (PGA 'clear' or 'almost clear' at 24 weeks in 66.7% vs. 37.0% respectively, p=0.025).[25]

Acitretin

A small study (n=60) showed that etanercept 25 mg twice weekly and etanercept 25 mg once weekly + acitretin 0.4 mg/kg/day had similar efficacy at week 24 (PASI 75: 45% and 44% respectively; mean BSA reduction: 80% and 78.2% respectively), suggesting that concomitant use of acitretin can lower the required dose of etanercept.[26]

Cyclosporine

Small case series suggest that etanercept can maintain control when cyclosporine discontinuation is needed.[23,27] In a small psoriatic arthritis study, addition of cyclosporine 3.0 mg/kg/day to 11 patients whose arthritis was in remission, but who had an insufficient skin response, resulted in 9/11 achieving PASI 75 at week 24.[28]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....