Combination Immunosuppressive Therapies

Robinson, Maria; Korman, Benjamin; Korman, Neil J.

doi:10.1001/archderm.143.8.1053

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…168,169 Although there is one anecdotal report of combining two biologic agents (efalizumab and etanercept) to treat patients with psoriasis and PsA, 170 increased toxicity without increased efficacy has been observed in two controlled studies of rheumatoid arthritis when two biologics were combined, even when the dosages were decreased. 171 Cyclosporine has been successfully combined with topical corticosteroids, anthralin, and topical vitamin D analogs with improved responses. [172][173][174] Other systemic treatments such as fumaric acid esters and mycophenolate mofetil have also been used in combination with cyclosporine, allowing for dose reduction of cyclosporine.…”

Section: Combination Therapy Of Systemic and Biologic Agentsmentioning

confidence: 99%

Guidelines of care for the management of psoriasis and psoriatic arthritis

Menter

Korman

Elmets

et al. 2011

Journal of the American Academy of Dermatology

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388

124

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Section: Combination Therapy Of Systemic and Biologic Agentsmentioning

confidence: 99%

Guidelines of care for the management of psoriasis and psoriatic arthritis

Menter

Korman

Elmets

et al. 2011

Journal of the American Academy of Dermatology

Self Cite

388

124

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“…In particular, patients with psoriasis are typically treated with monotherapy, whereas concomitant use of systemic immunosuppressants is common in the RA and IBD patient populations. 8, 9 Importantly, there may be a synergistic effect with the use of TNF antagonists and concomitant immunosuppressants on the risk of malignancy and serious infection 28…”

Section: Introductionmentioning

confidence: 99%

The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: A systematic review and meta-analysis of randomized controlled trials

Dommasch

Abuabara

Shin

et al. 2011

Journal of the American Academy of Dermatology

195

137

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Background There is a need to better understand the safety of TNF inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy. Objective Examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease. Methods Systematic search for trials of TNF antagonists for adults with plaque psoriasis (PsO) and psoriatic arthritis (PsA). We included randomized, placebo-controlled trials of etanercept, infliximab, adalimumab, golimumab, and certolizumab for the treatment of PsO and PsA. 20 out of 820 identified studies with a total of 6,810 patients were included. Results were calculated using fixed effects models and reported as pooled odds ratios (OR). Results ORs for overall infection and serious infection over a mean of 17.8 weeks were 1.18 (95% CI: 1.05, 1.33) and 0.70 (95% CI: 0.40, 1.21), respectively. When adjusting for patient-years, the incidence rate ratio for overall infection was 1.01 (95% CI: 0.92, 1.11). The OR for malignancy was 1.48 (95% CI: 0.71, 3.09), and 1.26 (95% CI: 0.39, 4.15) when non-melanoma skin cancer was excluded. Limitations Short duration of follow-up and rarity of malignancies and serious infections. Conclusions There is a small increased risk of overall infection with the short-term use of TNF antagonists for psoriasis that may be attributable to differences in follow-up time between treatment and placebo groups. There was no evidence of an increased risk of serious infection and a statistically significant increased risk in cancer was not observed with short-term use of TNF inhibitors.

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“…While psoriatic patients are typically treated with monotherapy, RA patients are commonly treated with multiple concomitant systemic immunosuppressants, including methotrexate and systemic corticosteroids . This is noteworthy as the concurrent use of TNF inhibitors and other systemic immunosuppressants has been shown to potentially create a synergistic effect on increasing the risk of serious infections . Interestingly, among Tsiodras et al .…”

Section: Discussionmentioning

confidence: 99%

“…59,60 This is noteworthy as the concurrent use of TNF inhibitors and other systemic immunosuppressants has been shown to potentially create a synergistic effect on increasing the risk of serious infections. 67 Interestingly, among Tsiodras et al 10 281 reported cases of fungal infections associated with TNF inhibitor use across indications, 98% (102/104) of patients for whom data was available reported use of at least one other immunosuppressant, commonly a systemic corticosteroid, associated with the development of the fungal infection. 10 In addition, it is important to remember that the deep fungal infections are endemic to specific geographical regions, and as Tsiodras et al 10 reported fungal infection rates among the various disease states are different in different countries.…”

Section: Discussionmentioning

confidence: 99%

The risk of deep fungal infections during biologic therapy for psoriasis

Jourabchi

Adelzadeh

2014

Acad Dermatol Venereol

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With a growing understanding of the pathogenesis and immunological basis of psoriasis, the medical community has seen the development of more focused biological treatment options for patients suffering from the disease, which are beginning to revolutionize the treatment of psoriasis. It is already well known that certain biologics are associated with an increased risk of reactivating tuberculosis in patients with latent disease, however, with increasing use of biologic agents across indications, there has also been a rise in reports of associated deep fungal infections. The mechanism of action of these biologic anti-psoriatic therapies allows physicians to address the underlying cause of patients' symptoms. The question though, is whether this same therapeutic mechanism may predispose patients to serious infections, including deep fungal infections.

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Combination Immunosuppressive Therapies

Cited by 9 publications

References 33 publications

Guidelines of care for the management of psoriasis and psoriatic arthritis

Guidelines of care for the management of psoriasis and psoriatic arthritis

The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: A systematic review and meta-analysis of randomized controlled trials

The risk of deep fungal infections during biologic therapy for psoriasis

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