Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks

Abstract

Etanercept combined with NB-UVB is more effective than etanercept monotherapy at 6 weeks as demonstrated at a clinical, histological and immunohistological level. However, as there is an increased risk for malignancy by treatment with TNF-α blockers alone or in combination with phototherapy, we recommend to restrict this highly effective combination to short periods of time, for instance to obtain a quicker response, and to avoid long-term treatment.

The effect of phototherapy on systemic inflammatory process in patients with plaque psoriasis

“…To the best of our knowledge, this is the first study that investigates the impact of phototherapy on unstimulated PBMCs in substantial group of patients with psoriasis. Precise insight into systemic immunomodulatory effect of phototherapy in humans may help to combine this treatment modality with other therapeutic strategies; recently it has been reported on beneficial combination of etanercept and NB-UVB that could be partly explained by reduction of IL-17A expression in PBMCs, showed in our study [24]. This study provides more insight into mechanisms of NB-UVB and bath-PUVA action.…”

“…TNF-α is potent, multifunctional pro-inflammatory cytokine, produced by monocytes/ macrophages, but also by lymphocytes (Th1-cells), dendritic cells and keratinocytes. It contributes to the development of insulin resistance and cardiovascular disorders [21,24]. IL-17A is mainly produced by Th17-cells but also by monocytes/macrophages, neutrophils and likely contributes to development of cardiovascular comorbidities [3,21,22].…”

Current Approach to Phototherapy Applications in Dermatology Practice: Part 2. Phototherapy in Vitiligo, Mycosis Fungoides, Atopic Dermatitis, Sclerosing Diseases and Psoriasis

“…Haftada iki gün 25 mg etanersept ile birlikte iki simetrik lezyondan tek tarafa dar bant UVB uygulanan bir çalışmada, altı hafta sonunda, dar bant UVB uygulanan lezyondaki düzelme oranı %64 iken, diğer tarafta bu oran %53,7 olarak saptanmıştır (98). Adalimumab kullanmakta olan dört psoriasis hastasının tek vücut yarısına altı hafta süreyle dar bant UVB uygulanan bir çalışmada ise, UVB uygulanmayan taraftaki düzelme oranı %53, UVB uygulanan taraftaki düzelme oranı %86 olarak bulunmuştur (99).…”

Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis

“…NB‐UVB has high efficacy, lacks systemic toxicity and is devoid of pharmacological interactions. A few clinical studies have determined that NB‐UVB enhances the efficacy of commercially available biologics, including ETN, adalimumab, ustekinumab, alefacept and efalizumab, with very good tolerability and without short‐term adverse events. However, concerns about long‐term adverse events, namely skin carcinogenesis, have been raised.…”