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Evidence-Based Recs Issued for Systemic Care in Psoriasis

Medical Board of the National Psoriasis Foundation offers best-practice recommendations

THURSDAY, Dec. 18, 2014 (HealthDay News) -- For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy with minimized toxicity, according to research published online Dec. 17 in JAMA Dermatology.

April W. Armstrong, M.D., M.P.H., from the University of Colorado Denver, and colleagues conducted a systematic review to develop evidence-based, best-practice recommendations for combination therapy for appropriately selected patients with psoriasis. Group discussions and voting were employed by the Medical Board of the National Psoriasis Foundation.

The researchers found that there were few trials that assessed the efficacy and safety of combination therapy in moderate to severe psoriasis. Combining biologics, such as etanercept or adalimumab, with phototherapy reduced disease severity more than either agent alone. Etanercept and methotrexate were more effective in combination than as monotherapy. Compared with infliximab alone, the combination of infliximab and methotrexate resulted in greater efficacy. Etanercept dose could be reduced to maintain similar levels of efficacy with concomitant use of acitretin. Psoriasis flares could be controlled with short-term cyclosporine use combined with etanercept or adalimumab. The preferred order for combining a second modality with biologics was: biologic and methotrexate; biologic and acitretin combination; and biologic and phototherapy combination. Insufficient data were available for combining biologics with acitretin, cyclosporine, or a second biologic.

"Among appropriately selected patients with psoriasis, carefully chosen combinations may result in greater efficacy, while minimizing toxicity," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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