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Psoriasis Psoriasis Treatment

Combination Therapy in the Treatment of Psoriasis

Summary & Participants

There are a variety of ways to treat psoriasis, but not all of them work for all people. Sometimes side effects prevent a treatment from being used long term. But today doctors are mixing new biologics and conventional treatments together to help make a difference in the lives of people living with this uncomfortable and unpleasant condition.

Medically Reviewed On: July 23, 2008

Webcast Transcript

ANNOUNCER: Fighting psoriasis is a life long battle for the 6 to 7 million people who struggle with this skin condition. The weapons in this battle come in several forms, including: creams; oral medications, like methotrexate or cyclosporine; light therapy; and a new class of drugs, called biologics. But sometimes just one therapy may not be enough.

ALAN MENTER, MD: We traditionally in dermatology have used what we call combination treatment whereby we combine one treatment with a second treatment, either simultaneously or as we're getting somebody off one treatment, we will start a second treatment in order to maintain the improvement in remission in psoriasis.

GERALD KRUEGER, MD: The thing that will cause me to go to a combination therapy most often is one treatment alone is not pulling the patient to their desired improvement level. And then we add a second therapy, and they can be combinations of systemic agents, pills, injections. They can be topical therapies. They can be light with systemic therapies. So there are lots of different combinations.

ANNOUNCER: The success of each therapy varies. When doctors don't see an adequate response, they call that a treatment failure.

ALAN MENTER, MD: If we take the PASI score, which is the Psoriasis Area Severity Index score that we used in research studies, if a patient has a score of 20 and this PASI score, after, say, a course of six weeks or twelve weeks of treatment is say 16 or 18. It hasn't reduced significantly. We would call that a failure.

ANNOUNCER: Sometimes the patient's lifestyle and the obligations of some therapies just aren't working.

GERALD KRUEGER, MD: They're on light therapy and something else,and they're having to go to the doctor's office two or three or four or five times a week to get light therapy, and they just don't have the time.

ANNOUNCER: While some effective therapies may take time to see a difference, using an additional therapy may cut the period it takes to achieve clear skin.

ALAN MENTER, MD: There is very good data out there now adding a little light treatment to Amevive treatment gets you significantly further along. Not only end results are better, but the short-term results; seeing Amevive takes a few weeks to kick in, light treatment may help to improve it for those people who want a quicker response.

ANNOUNCER: Sometimes effective psoriasis therapies can produce difficult side effects. PUVA, a form of light therapy, can increase the rate of skin cancer, while cyclosporine or methotrexate can cause organ toxicity. Combination therapy can cut down on the risk for problems.

ALAN MENTER, MD: The advantage of combination therapy is that you can take hopefully the good effects of each and maximize them in combination and reduce the potential side effects of each treatment. For instance, PUVA treatment and skin cancer, we can reduce significantly the number of PUVA treatments by combining it with a second drug. For instance, methotrexate needs a certain dose to clear them. If you add light treatment to methotrexate, you can reduce the total amount of methotrexate that is given.

ANNOUNCER: Of course combining any treatments must be done with caution.

GERALD KRUEGER, MD: There are some unholy combinations in combination therapy, yes. Number one that we really know about is cyclosporine and light. That is a combination that is not something you want to go with. Likelihood of getting skin cancers increases some five- to sixfold by doing that.

ALAN MENTER, MD: Studies are actually ongoing to look and see if you combine two systemic agents or even two biologic agents, what will the risks be? I think the reassuring data is out there in other diseases like rheumatoid arthritis and Crohn's where these drugs have been combined for many years without increasing the risk potential.

So we need to be cautious. I think we've devised what we believe are very safe combination therapies that maximize the benefits and reduce the risk.

ANNOUNCER: There are several effective treatments for people living with psoriasis. Treatments can be used alone or in combination, offering people with this condition many more options.

ALAN MENTER, MD: The best advice I would give a psoriasis patient either somebody who has struggled with their psoriasis for years and years, may have dropped out of treatment because of lack of treatment success, or patients who recently have been diagnosed with psoriasis, is there is a tremendous amount of research and interest in this disease. Do not lose hope. We now have drugs and medications that are specifically targeted to your disease that will keep you clear for longer periods of time. There is tremendous, tremendous optimism in the world of psoriasis.