Skip to main content
SpringerLink
Log in

Combination Therapy with Biologic Agents

  • Chapter
  • First Online:
Biologic Therapy for Psoriasis

Part of the book series: Updates in Clinical Dermatology ((UCD))

  • 532 Accesses

Abstract

Long-term remission of psoriasis can be difficult to achieve due to the waxing and waning nature of this chronic systemic inflammatory condition. With the advent of various biologic agents for the treatment of moderate-to-severe psoriasis, it is now possible for many patients to achieve adequate disease control with subsequent improvement in quality of life. However, in some circumstances, combining a biologic agent with one or more additional therapeutic modalities may be necessary to maintain adequate disease control. With the current armamentarium of available psoriasis therapies, there are many opportunities to combine various agents. However, when combining treatments, the provider must be aware of each treatment agent’s mechanism of action, safety profile, and drug-drug interactions so that an effective, yet safe, combination therapy can be instituted. Combination therapy must also consider patient acceptability and compliance, as well as cost. This chapter reviews the existing evidence of various combination therapies with biologic agents for the treatment of psoriasis, specifically the combination of biologic agents with phototherapy, traditional oral systemic agents such as methotrexate, acitretin, cyclosporine, newer systemic agents such as apremilast, and other biologic agents.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bhutani T, Patel T, Koo B, Nguyen T, Hong J, Koo J. A prospective, interventional assessment of psoriasis quality of life using a nonskin-specific validated instrument that allows comparison with other major medical conditions. J Am Acad Dermatol. 2013;69(2):e79–88. https://doi.org/10.1016/j.jaad.2012.10.009.

    Article  PubMed  Google Scholar 

  2. Emer J, Lebwohl MG. Combination, rotational, and sequential therapies. In: Koo JYM, Levin EC, Leon A, Wu JJ, Gottlieb AB, editors. Moderate to severe psoriasis. Boca Raton: CRC Press; 2015. p. 121–38.

    Google Scholar 

  3. Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol. 2004;50(3):416–30. https://doi.org/10.1016/j.jaad.2002.12.002.

    Article  PubMed  Google Scholar 

  4. Menter MA, See JA, Amend WJ, Ellis CN, Krueger GG, Lebwohl M, et al. Proceedings of the psoriasis combination and rotation therapy conference. Deer Valley, Utah, Oct. 7–9, 1994. J Am Acad Dermatol. 1996;34(2 Pt 1):315–21. https://doi.org/10.1016/s0190-9622(96)80148-4. Erratum in: J Am Acad Dermatol 1996 Jun;34(6):1029.

    Article  CAS  PubMed  Google Scholar 

  5. Weinstein GD, White GM. An approach to the treatment of moderate to severe psoriasis with rotational therapy. J Am Acad Dermatol. 1993;28(3):454–9. https://doi.org/10.1016/0190-9622(93)70067-4.

    Article  CAS  PubMed  Google Scholar 

  6. Koo J. Systemic sequential therapy of psoriasis: a new paradigm for improved therapeutic results. J Am Acad Dermatol. 1999;41(3 Pt 2):S25–8. https://doi.org/10.1016/s0190-9622(99)70363-4.

    Article  CAS  PubMed  Google Scholar 

  7. De Simone C, D'Agostino M, Capizzi R, Capponi A, Venier A, Caldarola G. Combined treatment with etanercept 50 mg once weekly and narrow-band ultraviolet B phototherapy in chronic plaque psoriasis. Eur J Dermatol. 2011;21(4):568–72. https://doi.org/10.1684/ejd.2011.1330.

    Article  CAS  PubMed  Google Scholar 

  8. Kircik L, Bagel J, Korman N, Menter A, Elmets CA, Koo J, et al. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol. 2008;7(3):245–53.

    PubMed  Google Scholar 

  9. Wolf P, Hofer A, Legat FJ, et al. Treatment with 311-nm ultraviolet B accelerates and improves the clearance of psoriatic lesions in patients treated with etanercept. Br J Dermatol. 2009;160(1):186–9. https://doi.org/10.1111/j.1365-2133.2008.08926.x.

    Article  CAS  PubMed  Google Scholar 

  10. Gambichler T, Tigges C, Scola N, et al. Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks. Br J Dermatol. 2011;164(6):1383–6. https://doi.org/10.1111/j.1365-2133.2011.10358.x.

    Article  CAS  PubMed  Google Scholar 

  11. Calzavara-Pinton PG, Sala R, Arisi M, Rossi MT, Venturini M, Ortel B. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol. 2013;169(1):130–6. https://doi.org/10.1111/bjd.12277. PMID: 23834117.

    Article  CAS  PubMed  Google Scholar 

  12. Lynde CW, Gupta AK, Guenther L, et al. A randomized study comparing the combination of nbUVB and etanercept to etanercept monotherapy in patients with psoriasis who do not exhibit an excellent response after 12 weeks of etanercept. J Dermatolog Treat. 2012;23(4):261–7. https://doi.org/10.3109/09546634.2011.607795.

    Article  CAS  PubMed  Google Scholar 

  13. Belinchón I, Arribas MP, Soro P, Betlloch I. Recovery of the response to biological treatments using narrow band ultraviolet-B in patients with moderate to severe psoriasis: a retrospective study of 17 patients. Photodermatol Photoimmunol Photomed. 2014;30(6):316–22. https://doi.org/10.1111/phpp.12134. PMID: 25132192.

    Article  CAS  PubMed  Google Scholar 

  14. Park KK, Swan J, Koo J. Effective treatment of etanercept and phototherapy-resistant psoriasis using the excimer laser. Dermatol Online J. 2012;18(3):2.

    PubMed  Google Scholar 

  15. Park KK, Wu JJ, Koo J. A randomized, ‘head-to-head’ pilot study comparing the effects of etanercept monotherapy vs. etanercept and narrowband ultraviolet B (NB-UVB) phototherapy in obese psoriasis patients. J Eur Acad Dermatol Venereol. 2013;27(7):899–906. https://doi.org/10.1111/j.1468-3083.2012.04611.x.

    Article  CAS  PubMed  Google Scholar 

  16. Strober B, Gottlieb A, Leonardi C, et al. Levels of response of psoriasis patients with different baseline characteristics treated with etanercept. J Am Acad Dermatol. 2006;54(3 Suppl):AB220.

    Google Scholar 

  17. Bagel J. Adalimumab plus narrowband ultraviolet B light phototherapy for the treatment of moderate to severe psoriasis. J Drugs Dermatol. 2011;10(4):366–71.

    PubMed  Google Scholar 

  18. Wolf P, Hofer A, Weger W, Posch-Fabian T, Gruber-Wackernagel A, Legat FJ. 311 nm ultraviolet B-accelerated response of psoriatic lesions in adalimumab-treated patients. Photodermatol Photoimmunol Photomed. 2011;27(4):86–9. https://doi.org/10.1111/j.1600-0781.2011.00594.x.

    Article  Google Scholar 

  19. Lucas A, Belinchón I, Pérez-Crespo M, Mataix J, Betlloch I. Successful response to narrow-band UVB in a patient undergoing concomitant treatment with adalimumab for psoriasis. Australas J Dermatol. 2008;49(3):173–4. https://doi.org/10.1111/j.1440-0960.2008.00458.x.

    Article  PubMed  Google Scholar 

  20. Wolf P, Weger W, Legat FJ, et al. Treatment with 311-nm ultraviolet B enhanced response of psoriatic lesions in ustekinumab-treated patients: a randomized intraindividual trial. Br J Dermatol. 2012;166(1):147–53. https://doi.org/10.1111/j.1365-2133.2011.10616.x.

    Article  CAS  PubMed  Google Scholar 

  21. Soro Martínez P, Belinchón Romero I, Arribas Granados MP. Restoration of response to ustekinumab with narrowband UV-B phototherapy. Actas Dermosifiliogr. 2014;105(2):200–2. https://doi.org/10.1016/j.ad.2013.03.007.

    Article  PubMed  Google Scholar 

  22. Farahnik B, Patel V, Beroukhim K, Zhu TH, Abrouk M, Nakamura M, et al. Combining biologic and phototherapy treatments for psoriasis: safety, efficacy, and patient acceptability. Psoriasis (Auckl). 2016;6:105–11. https://doi.org/10.2147/PTT.S98952.

    Article  CAS  Google Scholar 

  23. Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. J Am Acad Dermatol. 2009;60(6):1001–17. https://doi.org/10.1016/j.jaad.2008.12.031.

    Article  PubMed  Google Scholar 

  24. Wang E, Sasaki J, Nakamura M, Koo J. Cutaneous carcinogenic risk of phototherapy: an updated comprehensive review. J Psoriasis Psoriatic Arthritis. 2016;1:44–51.

    Article  Google Scholar 

  25. Bonomo L, Abittan BJ, Hashim PW, Karki C, Mason M, Lebwohl M. Combination use of systemic therapies in psoriasis: baseline characteristics from the Corrona Psoriasis Registry. J Drugs Dermatol. 2019;18(8):731–40.

    CAS  PubMed  Google Scholar 

  26. Adişen E, Aral A, Aybay C, Gürer MA. Anti-infliximab antibody status and its relation to clinical response in psoriatic patients: a pilot study. J Dermatol. 2010;37(8):708–13. https://doi.org/10.1111/j.1346-8138.2010.00882.x.

    Article  CAS  PubMed  Google Scholar 

  27. Vincent T, Best M, Plawecki M, Girard C. Complete reversion of anti-infliximab immunization by methotrexate combination in a patient with psoriasis. J Dermatol. 2015;42(10):1030–1. https://doi.org/10.1111/1346-8138.13010.

    Article  PubMed  Google Scholar 

  28. Farhangian ME, Feldman SR. Immunogenicity of biologic treatments for psoriasis: therapeutic consequences and the potential value of concomitant methotrexate. Am J Clin Dermatol. 2015;16(4):285–94. https://doi.org/10.1007/s40257-015-0131-y.

    Article  PubMed  Google Scholar 

  29. Gottlieb AB, Langley RG, Strober BE, Papp KA, Klekotka P, Creamer K, et al. A randomized, double-blind, placebo-controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis. Br J Dermatol. 2012;167(3):649–57. https://doi.org/10.1111/j.1365-2133.2012.11015.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zachariae C, Mørk NJ, Reunala T, et al. The combination of etanercept and methotrexate increases the effectiveness of treatment in active psoriasis despite inadequate effect of methotrexate therapy. Acta Derm Venereol. 2008;88(5):495–501. https://doi.org/10.2340/00015555-0511.

    Article  CAS  PubMed  Google Scholar 

  31. Yamauchi PS, Lowe NJ. Etanercept therapy allows the tapering of methotrexate and sustained clinical responses in patients with moderate to severe psoriasis. Int J Dermatol. 2008;47(2):202–4. https://doi.org/10.1111/j.1365-4632.2008.03419.x.

    Article  CAS  PubMed  Google Scholar 

  32. Sherman S, Hodak E, Pavlovsky L. Can etanercept treatment failure in moderate-to-severe psoriasis be overcome by addition of low-dose methotrexate? A single-center experience. J Dermatolog Treat. 2018;29(7):666–70. https://doi.org/10.1080/09546634.2018.1441491.

    Article  CAS  PubMed  Google Scholar 

  33. Foley PA, Quirk C, Sullivan JR, Dolianitis C, Hack SP, Thirunavukkarasu K, et al. Combining etanercept with traditional agents in the treatment of psoriasis: a review of the clinical evidence. J Eur Acad Dermatol Venereol. 2010;24(10):1135–43. https://doi.org/10.1111/j.1468-3083.2010.03613.x.

    Article  CAS  PubMed  Google Scholar 

  34. Yu Q, Tong Y, Cui L, Zhang L, Gong Y, Diao H, Gao F, Shi Y. Efficacy and safety of etanercept combined plus methotrexate and comparison of expression of pro-inflammatory factors expression for the treatment of moderate-to-severe plaque psoriasis. Int Immunopharmacol. 2019;73:442–50. https://doi.org/10.1016/j.intimp.2019.05.042.

    Article  CAS  PubMed  Google Scholar 

  35. Liu LF, Chen JS, Gu J, Xu JH, Jin HZ, Pang XW, et al. Etanercept biosimilar (recombinant human tumor necrosis factor-α receptor II: IgG Fc fusion protein) and methotrexate combination therapy in Chinese patients with moderate-to-severe plaque psoriasis: a multicentre, randomized, double-blind, placebo-controlled trial. Arch Dermatol Res. 2020;312(6):437–45. https://doi.org/10.1007/s00403-019-02024-6.

    Article  CAS  PubMed  Google Scholar 

  36. Philipp S, Wilsmann-Theis D, Weyergraf A, Rotterdam S, Frambach Y, Gerdes S, et al. Combination of adalimumab with traditional systemic antipsoriatic drugs - a report of 39 cases. J Dtsch Dermatol Ges. 2012;10(11):821–37. https://doi.org/10.1111/j.1610-0387.2012.07976.x.

    Article  PubMed  Google Scholar 

  37. van den Reek JM, van Lümig PP, Kievit W, Zweegers J, van de Kerkhof PC, Seyger MM, et al. Effectiveness of adalimumab dose escalation, combination therapy of adalimumab with methotrexate, or both in patients with psoriasis in daily practice. J Dermatolog Treat. 2013;24(5):361–8. https://doi.org/10.3109/09546634.2012.751483.

    Article  CAS  PubMed  Google Scholar 

  38. De Groot M, Teunissen MBM, Picavet DI, Wolbink GJ, Tal P, de Rie M, et al. Adalimumab in combination with methotrexate more effectively reduces the numbers of different inflammatory cell types in lesional psoriatic skin than does single treatment with adalimumab or methotrexate. Br J Dermatol. 2008;159:1401.

    Google Scholar 

  39. Dalaker M, Bonesrønning JH. Long-term maintenance treatment of moderate-to-severe plaque psoriasis with infliximab in combination with methotrexate or azathioprine in a retrospective cohort. J Eur Acad Dermatol Venereol. 2009;23(3):277–82. https://doi.org/10.1111/j.1468-3083.2008.03039.

    Article  CAS  PubMed  Google Scholar 

  40. Spertino J, Lopez-Ferrer A, Vilarrasa E, Puig L. Long-term study of infliximab for psoriasis in daily practice: drug survival depends on combined treatment, obesity and infusion reactions. J Eur Acad Dermatol Venereol. 2014;28(11):1514–21. https://doi.org/10.1111/jdv.12331.

    Article  CAS  PubMed  Google Scholar 

  41. Driessen RJ, van de Kerkhof PC, de Jong EM. Etanercept combined with methotrexate for high-need psoriasis. Br J Dermatol. 2008;159(2):460–3. https://doi.org/10.1111/j.1365-2133.2008.08669.x.

    Article  CAS  PubMed  Google Scholar 

  42. Iyer S, Yamauchi P, Lowe NJ. Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy. Br J Dermatol. 2002;146(1):118–21.

    Article  CAS  PubMed  Google Scholar 

  43. Strober BE, Clarke S. Etanercept for the treatment of psoriasis: combination therapy with other modalities. J Drugs Dermatol. 2004;3(3):270–2. https://doi.org/10.1046/j.0007-0963.2001.04529.x.

    Article  PubMed  Google Scholar 

  44. Muñoz-Santos C, Vidal D, Gomez-Vazquez M, Sola-Ortigosa J, Guilabert A. Etanercept and methotrexate combination therapy for the treatment of moderate to severe psoriasis: a retrospective multicentre study. Australas J Dermatol. 2016;57(4):e147–8. https://doi.org/10.1111/ajd.12495.

    Article  PubMed  Google Scholar 

  45. Atzeni F, Boccassini L, Antivalle M, Salaffi F, Sarzi-Puttini P. Etanercept plus ciclosporin versus etanercept plus methotrexate for maintaining clinical control over psoriatic arthritis: a randomised pilot study. Ann Rheum Dis. 2011;70(4):712–4. https://doi.org/10.1136/ard.2010.130864.

    Article  PubMed  Google Scholar 

  46. Babino G, Giunta A, Ruzzetti M, Sole Chimenti M, Chimenti S, Esposito M. Combination therapy with etanercept in psoriasis: retrospective analysis of efficacy and safety outcomes from real-life practice. J Int Med Res. 2016;44(1 suppl):100–5. https://doi.org/10.1177/0300060515593260.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Takeshita J, Wang S, Shin DB, Callis Duffin K, Krueger GG, Kalb RE, et al. Comparative effectiveness of less commonly used systemic monotherapies and common combination therapies for moderate to severe psoriasis in the clinical setting. J Am Acad Dermatol. 2014;71(6):1167–75. https://doi.org/10.1016/j.jaad.2014.08.003.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Busard CI, Cohen AD, Wolf P, Gkalpakiotis S, Cazzaniga S, Stern RS, et al. Biologics combined with conventional systemic agents or phototherapy for the treatment of psoriasis: real-life data from PSONET registries. J Eur Acad Dermatol Venereol. 2018;32(2):245–53. https://doi.org/10.1111/jdv.14583.

    Article  CAS  PubMed  Google Scholar 

  49. Heinecke GM, Luber AJ, Levitt JO, Lebwohl MG. Combination use of ustekinumab with other systemic therapies: a retrospective study in a tertiary referral center. J Drugs Dermatol. 2013;12(10):1098–102.

    CAS  PubMed  Google Scholar 

  50. Kostaki D, Aquila E, Macaluso L, Mattozzi C, Richetta AG. Optimizing secukinumab treatment in psoriasis with concomitant methotrexate administration: minireview and a case report. Case Rep Dermatol. 2019;11(Suppl 1):17–22. https://doi.org/10.1159/000501994.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Armesto S, González Vela C, Sánchez J, Illaro A, Mayorga J, López Sundh AE, et al. Treating multidrug-resistant psoriasis with brodalumab, apremilast, methotrexate and prednisone combination therapy in the COVID-19 pandemic. Dermatol Ther. 2020;33(6):e14464. https://doi.org/10.1111/dth.14464.

    Article  CAS  PubMed  Google Scholar 

  52. Hoffmann JHO, Knoop C, Schäkel K, Enk AH, Hadaschik EN. Long-term safety of combination treatment with methotrexate and tumor necrosis factor (TNF)-α antagonists versus TNF-α antagonists alone in psoriatic patients. J Dermatol. 2021;48(6):835–43. https://doi.org/10.1111/1346-8138.15754.

    Article  CAS  PubMed  Google Scholar 

  53. Conley J, Nanton J, Dhawan S, Pearce DJ, Feldman SR. Novel combination regimens: biologics and acitretin for the treatment of psoriasis - a case series. J Dermatol Treat. 2006;17:86–9. https://doi.org/10.1080/09546630500482928.

    Article  CAS  Google Scholar 

  54. Gisondi P, Del Giglio M, Cotena C, Girolomoni G. Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial. Br J Dermatol. 2008;158(6):1345–9. https://doi.org/10.1111/j.1365-2133.2008.08564.x.

    Article  CAS  PubMed  Google Scholar 

  55. Lee JH, Youn JI, Kim TY, Choi JH, Park CJ, Choe YB, et al. A multicenter, randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly, the combination of etanercept 25 mg twice weekly and acitretin, and acitretin alone in patients with moderate to severe psoriasis. BMC Dermatol. 2016;16(1):11. https://doi.org/10.1186/s12895-016-0048-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Smith EC, Riddle C, Menter MA, Lebwohl M. Combining systemic retinoids with biologic agents for moderate to severe psoriasis. Int J Dermatol. 2008;47(5):514–8. https://doi.org/10.1111/j.1365-4632.2008.03470.x.

    Article  PubMed  Google Scholar 

  57. Armstrong AW, Bagel J, Van Voorhees AS, Robertson AD, Yamauchi PS. Combining biologic therapies with other systemic treatments in psoriasis: evidence-based, best-practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015;151(4):432–8. https://doi.org/10.1001/jamadermatol.2014.3456.

    Article  PubMed  Google Scholar 

  58. Polat Ekinci A, Bölük KN, Babuna Kobaner G. Secukinumab and acitretin as a combination therapy for three clinical forms of severe psoriasis in multi-drug refractory patients: a case series of high efficacy and safety profile. Dermatol Ther. 2021;34(1):e14704. https://doi.org/10.1111/dth.14704.

    Article  CAS  PubMed  Google Scholar 

  59. Lee EJ, Shin MK, Kim NI. A clinical trial of combination therapy with etanercept and low dose cyclosporine for the treatment of refractory psoriasis. Ann Dermatol. 2010;22(2):138–42. https://doi.org/10.5021/ad.2010.22.2.138.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. D’Angelo S, Cutro MS, Lubrano E, Leccese P, Mennillo GA, Ferrara N, et al. Combination therapy with ciclosporin and etanercept in patients with psoriatic arthritis. Ann Rheum Dis. 2010;69(5):934–5. https://doi.org/10.1136/ard.2009.119446.

    Article  CAS  PubMed  Google Scholar 

  61. Karanikolas GN, Koukli EM, Katsalira A, Arida A, Petrou D, Komninou E, et al. Adalimumab or cyclosporine as monotherapy and in combination in severe psoriatic arthritis: results from a prospective 12-month nonrandomized unblinded clinical trial. J Rheumatol. 2011;38(11):2466–74. https://doi.org/10.3899/jrheum.110242.

    Article  CAS  PubMed  Google Scholar 

  62. Yamauchi PS, Lowe NJ. Cessation of cyclosporine therapy by treatment with etanercept in patients with severe psoriasis. J Am Acad Dermatol. 2006;54(3 suppl 2):S135–8.

    Article  PubMed  Google Scholar 

  63. Cohen Barak E, Kerner M, Rozenman D, Ziv M. Combination therapy of cyclosporine and anti-tumor necrosis factor α in psoriasis: a case series of 10 patients. Dermatol Ther. 2015;28(3):126–30. https://doi.org/10.1111/dth.12196.

    Article  PubMed  Google Scholar 

  64. Gattu S, Wu J, Koo J. Can adalimumab make a smooth and easy transition from cyclosporine a reality? A case series of successful transitions. Psoriasis Forum. 2009;15a(2):33–5. https://doi.org/10.1177/247553030915a00206.

    Article  Google Scholar 

  65. Ortiz A, Yamauchi PS. A treatment strategy for psoriasis: transitioning from systemic therapy to biologic agents. Skinmed. 2006;5:285–8. https://doi.org/10.1111/j.1540-9740.2006.05679.x.

    Article  PubMed  Google Scholar 

  66. Di Lernia V, Rossi F, De Fanti A. Etanercept combined with cyclosporine in a 6-year-old child with severe plaque psoriasis. J Dtsch Dermatol Ges. 2016;14(10):1042–3. https://doi.org/10.1111/ddg.13062.

    Article  PubMed  Google Scholar 

  67. Georgesen C, Wildman H, Wang X, Magro C. Pediatric pustular psoriasis responsive to cyclosporine bridged to etanercept: a treatment approach. Dermatol Online J. 2017;23(11). pii: 13030/qt9787b6c0.

    Google Scholar 

  68. Paul CF, Ho VC, McGeown C, Christophers E, Schmidtmann B, Guillaume JC, et al. Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study. J Invest Dermatol. 2003;120(2):211–6. https://doi.org/10.1046/j.1523-1747.2003.12040.x.

    Article  CAS  PubMed  Google Scholar 

  69. AbuHilal M, Walsh S, Shear N. Use of apremilast in combination with other therapies for treatment of chronic plaque psoriasis: a retrospective study. J Cutan Med Surg. 2016;20(4):313–6. https://doi.org/10.1177/1203475416631328.

    Article  CAS  PubMed  Google Scholar 

  70. Danesh MJ, Beroukhim K, Nguyen C, Levin E, Koo J. Apremilast and adalimumab: a novel combination therapy for recalcitrant psoriasis. Dermatol Online J. 2015;21(6). pii: 13030/qt5gf406zs.

    Google Scholar 

  71. Rothstein BE, McQuade B, Greb JE, Goldminz AM, Gottlieb AB. Apremilast and secukinumab combined therapy in a patient with recalcitrant plaque psoriasis. J Drugs Dermatol. 2016;15(5):648–9.

    CAS  PubMed  Google Scholar 

  72. Sacchelli L, Patrizi A, Loi C, Bardazzi F. Combination therapy of apremilast and secukinumab in patients with moderate-to-severe, recalcitrant plaque psoriasis. Clin Exp Dermatol. 2019;44(7):e243–4. https://doi.org/10.1111/ced.14000.

    Article  CAS  PubMed  Google Scholar 

  73. Cuchacovich R, Garcia-Valladares I, Espinoza LR. Combination biologic treatment of refractory psoriasis and psoriatic arthritis. J Rheumatol. 2012;39(1):187–93. https://doi.org/10.3899/jrheum.110295.

    Article  PubMed  Google Scholar 

  74. Babalola O, Lakdawala N, Strober BE. Combined biologic therapy for the treatment of psoriasis and psoriatic arthritis: a case report. JAAD Case Rep. 2015;1(1):3–4. https://doi.org/10.1016/j.jdcr.2014.09.002.

    Article  PubMed  Google Scholar 

  75. Gniadecki R, Bang B, Sand C. Combination of antitumour necrosis factor-alpha and anti-interleukin-12/23 antibodies in refractory psoriasis and psoriatic arthritis: a long-term case-series observational study. Br J Dermatol. 2016;174(5):1145–6. https://doi.org/10.1111/bjd.14270.

    Article  CAS  PubMed  Google Scholar 

  76. Torre KM, Payette MJ. Combination biologic therapy for the treatment of severe palmoplantar pustulosis. JAAD Case Rep. 2017;3(3):240–2. https://doi.org/10.1016/j.jdcr.2017.03.002.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Rathod D, Weinberg JM, Yamauchi PS. Successful treatment of refractory plaque-type psoriasis and psoriatic arthritis with guselkumab and adalimumab combination therapy: a case report. J Drugs Dermatol. 2019;18(4):394–6.

    PubMed  Google Scholar 

  78. Thibodeaux Q, Ly K, Reddy V, Smith MP, Liao W. Dual biologic therapy for recalcitrant psoriasis and psoriatic arthritis. JAAD Case Rep. 2019;5(10):928–30. https://doi.org/10.1016/j.jdcr.2019.08.015.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Kourtney Pony

  2. Department of Dermatology, University of Michigan, Ann Arbor, MI, USA

    Mio Nakamura

Authors
  1. Kourtney Pony
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mio Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mio Nakamura .

Editor information

Editors and Affiliations

  1. Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA

    Nicholas Brownstone

  2. Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA

    Tina Bhutani

  3. Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA

    Wilson Liao

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pony, K., Nakamura, M. (2022). Combination Therapy with Biologic Agents. In: Brownstone, N., Bhutani, T., Liao, W. (eds) Biologic Therapy for Psoriasis. Updates in Clinical Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-030-92938-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-92938-1_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-92937-4

  • Online ISBN: 978-3-030-92938-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation