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Combination Therapy in Psoriasis

An Evidence-Based Review

Abstract

Background

Psoriasis is a chronic, systemic, inflammatory condition for which a variety of treatment modalities exist. Combinations of therapies are used often in clinical practice to enhance efficacy and reduce drug toxicities.

Purpose

The purpose of this review is to assess the literature on the efficacy and safety of combination therapy in the treatment of psoriasis.

Methods

MEDLINE was reviewed to identify English-language publications from 1966 to 2011 examining combination therapy in psoriasis. Fifty-three articles met inclusion criteria and were included in this review. Randomized controlled trials addressing various combinations of treatment modalities for psoriasis were included. Data from these clinical studies were summarized and the outcomes were discussed.

Results

Large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis are limited. The strongest data support the use of combinations of vitamin D derivatives and corticosteroids as topical combinations and, to a lesser extent, the combination of other topical agents. Phototherapy and topical vitamin D derivatives as well as phototherapy in combination with oral retinoids are well supported in the literature. Combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety.

Limitations

Our data were limited by the small number of clinical trials examining the multiple available combinations that are used in clinical practice.

Conclusions

The use of combination treatments falls within the standard of care for psoriasis, even if these combinations have not been extensively studied in clinical trials.

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Acknowledgments

No sources of funding were received to prepare this article. Dr. Feldman has received research, speaking and/or consulting support from Galderma Laboratories L.P., GSK/Stiefel, Leo Pharma, Abbott, Amgen, Astellas, Janssen, Taro, National Biological Corporation, National Psoriasis Foundation, and Novartis; he is the founder and majority owner of http://www.DrScore.com, and the founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. The other authors have no conflicts of interest that are directly relevant to the content of this article.

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Correspondence to Steven R. Feldman.

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Gustafson, C.J., Watkins, C., Hix, E. et al. Combination Therapy in Psoriasis. Am J Clin Dermatol 14, 9–25 (2013). https://doi.org/10.1007/s40257-012-0003-7

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Keywords

  • Psoriasis
  • Topical Corticosteroid
  • Plaque Psoriasis
  • Topical Agent
  • Calcipotriol