Systemic Combination Treatment for Psoriasis: A Review

Abstract

Psoriasis is a chronic inflammatory skin disease, which affects approximately 2.6% of the population in Northern Europe and Scandinavia. In order to achieve disease control, combinations of systemic treatments are sometimes needed for variable time periods. However, no evidence-based guidelines exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination treatments. The most thoroughly investigated combination was retinoid and phototherapy. Further controlled research is needed to define the safest and most effective combination regimens.

Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

“…2,4 Pada kasus yang berat dan tidak memperlihatkan perbaikan sesudah dilakukan terapi tunggal, dapat dipertimbangkan pemberian terapi kombinasi. 5 Terapi kombinasi mampu meningkatkan efektivitas dan mengurangi efek samping obat. 2,5 Terdapat suatu penelitian yang melaporkan terapi kombinasi MTX dan beberapa obat, di antaranya MTX dengan siklosporin dan memberikan hasil yang baik tanpa efek samping yang menetap.…”

“…5 Terapi kombinasi mampu meningkatkan efektivitas dan mengurangi efek samping obat. 2,5 Terdapat suatu penelitian yang melaporkan terapi kombinasi MTX dan beberapa obat, di antaranya MTX dengan siklosporin dan memberikan hasil yang baik tanpa efek samping yang menetap.…”

“…11 Terapi kombinasi dapat dipertimbangkan pada PPG kasus yang berat atau yang tidak menunjukkan perbaikan setelah terapi tunggal. 5 Terapi kombinasi juga diharapkan mampu meningkatkan efektivitas terapi dan mengurangi efek samping yang dapat ditimbulkan obat-obat monoterapi dalam jangka waktu yang lama. 2,12 Salah satu kombinasi yang dapat digunakan adalah kombinasi MTX dan siklosporin.…”

Severe exacerbation of psoriasis after cessation of methotrexate therapy successfully treated with cyclosporin A

“…However, since the therapeutic effect was unsatisfactory, cyclosporin A was added to the treatment regimen within a short time, leading to a rapid clinical improvement. The available literature describes cases of effective combination therapy with methotrexate and cyclosporin A in cases of severe treatment-refractory psoriasis including erythrodermic psoriasis [6][7][8][9][10]. It represents a potential alternative therapy in patients who do not tolerate well high doses of a single drug or whose condition fails to improve sufficiently in response to treatment based on one of the two medications.…”

“…Combined treatment may lead to more rapid regression of cutaneous lesions, however it should be stressed that such therapy carries a greater risk of adverse reactions, particularly infectious complications [11]. On the other hand, based on the available data [6][7][8][9][10], methotrexate combined with cyclosporin A seems to be a relatively safe therapeutic modality, provided that follow-up examinations are systematically performed and the treatment is monitored on an ongoing basis. It is important to note, though, that data on the long-term safety of using this drug combination are insufficient.…”