High-need psoriatic patients are often treated with combinations of systemic agents. Among the newly introduced biological drugs, tumour necrosis factor (TNF)-alpha inhibitors are increasingly being combined with a traditionalagent-usually methotrexate-to improve long-term disease control and drug survival. Although cyclosporineA is one of the most effective systemic anti-psoriatic agents, there are limited data on its combination with new biological drugs. We retrospectively reviewed cases treated with a biological drug and cyclosporine A among highneed psoriasis patients undergoing combination treatment regimens at a tertiary dermatologic referral centre. We also reviewed previously published reports of psoriatic patients receiving similar treatment strategies. Among high-need patients receiving combination therapy (n=30), nine cases were treated with a biological drug (adalimumab, infliximab, etanercept or ustekinumab) in combination with one or more intermittent cycles of cyclosporine A for at least 8 weeks. Four cases presented severe clinical phenotypes (generalized pustular, erythrodermic psoriasis).Combination of TNF-alpha antagonists and cyclosporine A has been reported previously mostly in the setting of psoriatic arthritis. Although not recommended by current treatment guidelines, combination therapy of psoriasis with a biologic and cyclosporine A may be used on an individual case-basis to manage disease flares and to increase drug survival.
Combined use of cyclosporine A and biologicals to treat high-need psoriasis: a single-center experience
Garcovich, Simone;
2013-01-01
Abstract
High-need psoriatic patients are often treated with combinations of systemic agents. Among the newly introduced biological drugs, tumour necrosis factor (TNF)-alpha inhibitors are increasingly being combined with a traditionalagent-usually methotrexate-to improve long-term disease control and drug survival. Although cyclosporineA is one of the most effective systemic anti-psoriatic agents, there are limited data on its combination with new biological drugs. We retrospectively reviewed cases treated with a biological drug and cyclosporine A among highneed psoriasis patients undergoing combination treatment regimens at a tertiary dermatologic referral centre. We also reviewed previously published reports of psoriatic patients receiving similar treatment strategies. Among high-need patients receiving combination therapy (n=30), nine cases were treated with a biological drug (adalimumab, infliximab, etanercept or ustekinumab) in combination with one or more intermittent cycles of cyclosporine A for at least 8 weeks. Four cases presented severe clinical phenotypes (generalized pustular, erythrodermic psoriasis).Combination of TNF-alpha antagonists and cyclosporine A has been reported previously mostly in the setting of psoriatic arthritis. Although not recommended by current treatment guidelines, combination therapy of psoriasis with a biologic and cyclosporine A may be used on an individual case-basis to manage disease flares and to increase drug survival.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
