BACKGROUND
Treatment of moderate-to-severe psoriasis often poses a challenge to the physician.1 Patients with widespread disease frequently fail to respond to initial topical treatments and phototherapy and quickly move to the next therapeutic step: single-agent systemic therapy. However, systemic monotherapy can be insufficient in attaining the desired level of control, and increasing the dose of many of the first-line medications may pose a safety risk to the patient.
Combination therapies present another option in these difficult cases.2 Combination therapies for moderate-to-severe psoriasis may consist of two systemic agents or one systemic agent with topical or phototherapy. While there are numerous studies establishing the safety and efficacy of the latter, data regarding systemic combination therapy are limited. There is evidence that methotrexate (MTX) and cyclosporine (CsA) can be used together effectively.3 However, both of these medications are associated with significant side effects and consistent monitoring is required throughout treatment. Newer therapies such as systemic retinoids, phosphodiesterase inhibitors, and biologic drugs have comparatively more favorable side effect profiles.4 As such, physicians have begun to use these drugs in combination with traditional systemic agents and, in some cases, with one another.
There is a paucity of literature related to combination therapies involving these newer agents.5 Initial investigations suggest that biologic drugs in combination with CsA, MTX, acitretin, or
Combination therapies present another option in these difficult cases.2 Combination therapies for moderate-to-severe psoriasis may consist of two systemic agents or one systemic agent with topical or phototherapy. While there are numerous studies establishing the safety and efficacy of the latter, data regarding systemic combination therapy are limited. There is evidence that methotrexate (MTX) and cyclosporine (CsA) can be used together effectively.3 However, both of these medications are associated with significant side effects and consistent monitoring is required throughout treatment. Newer therapies such as systemic retinoids, phosphodiesterase inhibitors, and biologic drugs have comparatively more favorable side effect profiles.4 As such, physicians have begun to use these drugs in combination with traditional systemic agents and, in some cases, with one another.
There is a paucity of literature related to combination therapies involving these newer agents.5 Initial investigations suggest that biologic drugs in combination with CsA, MTX, acitretin, or