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Combining biologic and phototherapy for the treatment of moderate-to-severe psoriasis

Combination of biologic and phototherapy might be effective for the treatment of moderate-to-severe psoriasis not responsive to monotherapy, researchers reported in Psoriasis Targets and Therapy (July 28, 2016; (6):105–111).

During the literature review study, the investigators searched PubMed for studies that evaluated the safety and efficacy of the combination of biologic and narrowband ultraviolet B phototherapy in moderate-to-severe psoriasis.

The primary literature found by the researchers consisted of randomized controlled trials, a head-to-head study, open-label controlled and uncontrolled trials, case series, and case reports. The authors indicated that etanercept was used in over half of the reported cases, but other biologic agents used included ustekinumab, adalimumab, and infliximab. The majority of phototherapy utilized was narrowband ultraviolet B radiation.

Findings revealed that most cases reported enhanced improvement with combination therapy. Data also showed that serious adverse events were reported in less than 3% of the patients, the authors wrote.

“Although no regimen involving the combination of a biologic agent and phototherapy has been approved for the management of moderate to severe psoriasis, combination therapy appears to be a viable clinical strategy, especially for psoriasis unresponsive to monotherapy,” said Dr. Benjamin Farahnik, lead author and clinical research coordinator at the University of California San Francisco Psoriasis & Skin Treatment Center in San Francisco.

Dr. Farahnik added that narrowband ultraviolet B in combination with biologics appears to be especially effective.

“Skilfully combining biologic agents with non-biologic treatments broadens the armamentarium for the long-term control of psoriasis without much increase in risks. Nevertheless, further studies are required to assess the long-term safety and efficacy of such combinations,” said Dr. Farahnik, as quoted in a press release.

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