INTRODUCTION
Estimates suggest that more than half of all patients with psoriasis are dissatisfied with their treatment.1,2 Even in light of significant recent therapeutic advancements, many patients with psoriasis will use a combination of treatments at some point in the disease course, with the goal to increase the speed and/or degree of therapeutic response. However, despite the frequency with which combinations in clinical practice are used, there are few large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis.3 Prescribers are challenged to create combination regimens that offer both efficacy and safety.4 In many instances, the combination of a topical agent with a systemic agent is preferred, as the differing modes of administration are expected to reduce the risk for drug interactions.
An increasingly common combination approach pairs apremilast (Otezla, Amgen), an oral phosphodiesterase 4 inhibitor, with a topical aerosol foam formulation of fixed combination calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD, Enstilar, Leo Pharma).
Apremilast is approved for treatment of moderate to severe psoriasis, and has demonstrated a favorable safety profile.5 It has been suggested by a consensus panel of experts to be particularly appropriate for management of patients with stable moderate psoriasis.6 Relative to conventional oral agents and biologic therapies, apremilast requires less prescreening and monitoring.6 In Phase III trials of apremilast for psoriasis, 33% of subjects receiving active treatment achieved PASI 75 at week 16, compared to 5% of placebo controls.7 Topically applied calcipotriene and betamethasone dipropionate
An increasingly common combination approach pairs apremilast (Otezla, Amgen), an oral phosphodiesterase 4 inhibitor, with a topical aerosol foam formulation of fixed combination calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD, Enstilar, Leo Pharma).
Apremilast is approved for treatment of moderate to severe psoriasis, and has demonstrated a favorable safety profile.5 It has been suggested by a consensus panel of experts to be particularly appropriate for management of patients with stable moderate psoriasis.6 Relative to conventional oral agents and biologic therapies, apremilast requires less prescreening and monitoring.6 In Phase III trials of apremilast for psoriasis, 33% of subjects receiving active treatment achieved PASI 75 at week 16, compared to 5% of placebo controls.7 Topically applied calcipotriene and betamethasone dipropionate