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Combination Therapy with Biologics and Other Systemic Treatments in Psoriasis

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Biologic and Systemic Agents in Dermatology

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Abstract

Psoriasis is a common, chronic inflammatory disease associated with multiple comorbidities. The traditional therapies for moderate-to-severe psoriasis include phototherapy and systemic oral agents such as methotrexate, acitretin, and cyclosporine. Biologic agents, including etanercept, adalimumab, infliximab, ustekinumab, secukinumab, and ixekizumab, have changed the psoriasis armamentarium and have become widely used to treat moderate-to-severe psoriasis. While biologic monotherapies are effective for many patients, some patients have refractory psoriasis and may require combination approaches. Combination therapy with biologics may increase efficacy without additional toxicity. Selection of combination therapy depends on patient demographics, comorbidities, psoriasis disease severity, and previously attempted therapies. Combination therapy with biologics and methotrexate contains the most evidence, followed by combination therapy with acitretin and then NB-UVB. However, the amount of existing evidence does not necessarily correlate with effectiveness. Treatment decisions must be made on an individual basis, and further studies are needed to elucidate which combination therapies are most effective. This chapter will discuss and evaluate the data on combining various biologic agents with methotrexate, acitretin, cyclosporine, and phototherapy.

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Authors and Affiliations

  1. Department of Dermatology, University of Southern California, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA, 90089, USA

    Kaitlyn M. Yim BA & April W. Armstrong MD, MPH

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Correspondence to April W. Armstrong MD, MPH .

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  1. Division of Dermatology, David Geffen School of Medicine a UCLA, Los Angeles, California, USA

    Paul S. Yamauchi

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Yim, K.M., Armstrong, A.W. (2018). Combination Therapy with Biologics and Other Systemic Treatments in Psoriasis. In: Yamauchi, P. (eds) Biologic and Systemic Agents in Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-66884-0_23

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