Background: Methotrexate (MTX) and cyclosporine have been used as effective systemic mono-therapy for psoriasis. Several factors are considered to switch monotherapy to combination therapy because monotherapy is no longer effective and has higher side effects. Hence,clinicians have avoided systemic therapy combinations due to its toxicity. However, some studies showed that this combination therapy could be usedeffectively for psoriasis patients. Purpose: This study aimed to analyze the efficacy and adverse effects of systemic MTX and cyclosporine combination therapy in Indonesian psoriasis vulgaris patients. Methods: The retrospective study assessed the effectiveness of 3 monthsmono-therapyand combination therapy of systemic MTX and cyclosporine in psoriasisvulgaris patients from 2016–2017 in Dermatology Clinic, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia. Result: Psoriasis area and severity index (PASI) score 90 were achieved in the group MTX (50%) and cyclosporine group (50%), while none in the combination group.However, eight patients (50%) in group MTX and cyclosporine reached the primary endpoint of PASI 50. One patient in cyclosporine group had adverse effects on kidney profiles. Nonetheless, other patients had no biochemical changes. But, there was no significant difference in the change of PASI between each group (p=0.102). Conclusion: We propose that combination therapy of MTX and cyclosporine is relatively safe and efficacious in treating Indonesian psoriasis vulgaris patients. This combination treatment isas effective as MTX or cyclosporinemono-therapy.
Vitiligo is an acquired depigmentation disorder with exact etiology is not yet known. Autoimmune hypothesis plays an important role in the mechanism of vitiligo and has been related to lower levels of 25- hydroxyvitamin D (25-(OH)D). This study aimed to analyze the comparison effect of combination therapy of NB-UVB phototherapy and vitamin D3 supplement toward NB-UVB phototherapy alone to increase of serum 25-(OH)D levels in vitiligo patients. Subjects consisted of 24 adult vitiligo patients: group I was given a combination of NB-UVB phototherapy and 5000 IU vitamin D3 once daily; while group II was given monotherapy of NB-UVB. There was a very significant increase of serum 25- (OH)D level in group I with an average increase was 288.65%, while group II showed a significant increase of serum 25- (OH)D serum with an average increase was 33.63%. The very significant result was seen between both groups. None of the subjects showed signs of vitamin D toxicities during treatment. The study concluded that combination of NB-UVB phototherapy and vitamin D3 supplementation gave a better effect to increase of serum 25-(OH)D levels in adult vitiligo patients.
Khairani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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