Combination Biologic Treatment of Refractory Psoriasis and Psoriatic Arthritis

Cuchacovich, Raquel; García-Valladares, Ignacio; Espinoza, Luis R.

doi:10.3899/jrheum.110295

Cited by 29 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…suggestive of a TNFα-dependent arthropathy concomitant to an IL-23/17-axis-dependent psoriasis occurring in a subset of cases(2) (Figure 1). To our knowledge, there are only a few reports(3,4) on the combination of bDMARDs in severe, refractory PsA. In our series, singletargeted inhibition was inadequate to gain full control on disease activity, triggering the decision to trial a bDMARDs combination to selectively inhibit different cytokines.…”

mentioning

confidence: 85%

Combined inhibition of tumour necrosis factor-alpha and interleukin-12/23 for long-standing, refractory psoriatic disease: a differential role for cytokine pathways?

et al. 2018

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 85%

Combined inhibition of tumour necrosis factor-alpha and interleukin-12/23 for long-standing, refractory psoriatic disease: a differential role for cytokine pathways?

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Minimal literature on the effectiveness of biologic combination therapy is available, warranting the need for studies evaluating the combination of two biologics for PsA [169–173]. The EULAR guidelines further note that clinical trials to date have not shown superiority with combination use of TNF inhibitors and synthetic DMARDs versus TNF inhibitor monotherapy, and additional trials are needed [89].…”

Section: Patient Assessment Staging and Treatment Planmentioning

confidence: 99%

Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis

Mease

Armstrong

2014

Drugs

224

208

View full text Add to dashboard Cite

Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. Up to 40 % of patients with psoriasis will go on to develop PsA, usually within 5–10 years of cutaneous disease onset. Both conditions share common pathogenic mechanisms involving genetic and environmental factors. Because psoriasis is typically present for years before PsA-related joint symptoms emerge, dermatologists are in a unique position to detect PsA earlier in the disease process through regular, routine screening of psoriasis patients. Distinguishing clinical features of PsA include co-occurrence of psoriatic skin lesions and nail dystrophy, as well as dactylitis and enthesitis. Patients with PsA are usually seronegative for rheumatoid factor, and radiographs may reveal unique features such as juxta-articular new bone formation and pencil-in-cup deformity. Early treatment of PsA with disease-modifying anti-rheumatic drugs has the potential to slow disease progression and maintain patient quality of life. Optimally, a single therapeutic agent will control both the skin and joint psoriatic symptoms. A number of traditional treatments used to manage psoriasis, such as methotrexate and cyclosporine, are also effective for PsA, but these agents are often inadequately effective, temporary in benefit and associated with significant safety concerns. Biologic anti-tumour necrosis factor agents, such as etanercept, infliximab and adalimumab, are effective for treating patients who have both psoriasis and PsA. However, a substantial number of patients may lose efficacy, have adverse effects or find intravenous or subcutaneous administration inconvenient. Emerging oral treatments, including phosphodiesterase 4 inhibitors, such as apremilast, and new biologics targeting interleukin-17, such as secukinumab, brodalumab and ixekizumab, have shown encouraging clinical results in the treatment of psoriasis and/or PsA. Active and regular collaboration of dermatologists with rheumatologists in managing patients who have psoriasis and PsA is likely to yield more optimal control of psoriatic dermal and joint symptoms, and improve long-term patient outcomes.

show abstract

“…Two of the 3 case reports using this combination demonstrated improved psoriasis and psoriatic arthritis, but noted 2 AEs. Cuchacovich et al 10 reported the successful use of etanercept with ustekinumab to treat the skin and nail manifestations and synovitis that were occurring secondary to severe refractory psoriasis and psoriatic arthritis. Improved composite disease activity indices and no AEs were noted at 11 months of follow-up on these combined agents.…”

Section: Combination Therapy In Dermatologic Conditionsmentioning

confidence: 99%

Combining Biologics in Inflammatory Bowel Disease and Other Immune Mediated Inflammatory Disorders

Hirten

Iacucci

Shah

et al. 2018

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Current therapies used in the treatment of inflammatory bowel disease (IBD) are not effective in all patients. Biologic agents result in approximately 40% remission rates at 1 year in selected populations, prompting a growing interest in combining biologic therapy to improve outcomes. There are limited published data regarding the efficacy and safety of combination targeted therapy in IBD specifically, which include only 1 exploratory randomized control trial and 3 case reports or series. This review evaluates the published literature regarding this therapeutic paradigm in IBD and its extensive utilization in the treatment of other immune-mediated inflammatory disorders. The combination of biologic therapies demonstrates variable degrees of efficacy and highlights some safety concerns, depending upon the agents used and the disease state treated. A trial (Clinical Trials.gov Identifier: NCT02764762) combining vedolizumab and adalimumab is currently underway evaluating the effectiveness and safety of this approach in patients with Crohn's disease, which should provide further insight into this treatment concept. While combination biologic therapy is an attractive strategy, the lack of consistent superior efficacy as well as safety concerns militates the need for further trials prior to its general application in IBD.

show abstract

Combination Biologic Treatment of Refractory Psoriasis and Psoriatic Arthritis

Cited by 29 publications

References 27 publications

Combined inhibition of tumour necrosis factor-alpha and interleukin-12/23 for long-standing, refractory psoriatic disease: a differential role for cytokine pathways?

Combined inhibition of tumour necrosis factor-alpha and interleukin-12/23 for long-standing, refractory psoriatic disease: a differential role for cytokine pathways?

Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis

Combining Biologics in Inflammatory Bowel Disease and Other Immune Mediated Inflammatory Disorders

Contact Info

Product

Resources

About