A Clinical Trial of Combination Therapy with Etanercept and Low Dose Cyclosporine for the Treatment of Refractory Psoriasis

Abstract

Background: Over the past decade, combination therapies have become a mainstay of dermatologic care in psoriasis. Combination therapies are often more effective and safer than large dose single-agent therapies. With the emergence of new biologic therapies, dermatologists now have a wider array of tools to treat psoriasis. Although much data exists regarding cyclosporine or biologic agents alone for psoriasis, little is known about the efficacy, safety and tolerability of combination regimens. Objective: We designed a study to evaluate the efficacy and safety of etanercept and cyclosporin combination therapy in patients with refractory psoriasis. Methods: We administered oral cyclosporine (200 mg daily) and subcutaneous etanercept 50 mg weekly injections until symptoms improved, then maintained treatment at a reduced dose. Seven patients with refractory psoriasis were evaluated 4 weekly. Results: All 7 patients showed rapid responses to combination therapy. Mean Psoriasis Area and Severity Index reductions following conditioning therapy (mean: 6.85 weeks) and maintenance therapy (mean: 56.5 weeks) were 94.9% and 93.2%, respectively. Conclusion: Etanercept and low-dose cyclosporine combination therapy appears to be a safe and efficacious alternative treatment strategy for patients with refractory psoriasis. The combination induced rapid improvement in patients with refractory psoriasis and dramatically improved their quality of life. Clinical studies including larger patient cohort are required to validate the safety and efficacy of this combination therapy. (Ann Dermatol 22(2) 138∼142, 2010)

Combination of Etanercept and Twice-Weekly Administration of Cyclosporin in Psoriasis Unsatisfactorily Controlled by Etanercept Monotherapy: A Retrospective Analysis

“…Similar response rates were sustained during a maintenance treatment with CsA 100mg/day and etanercept 25 mg BIW for 16-64 weeks (8).…”

Systematic review on the maintenance of response during systemic antipsoriatic therapy

“…Data on etanercept for patients who have responded to induction therapy are available from uncontrolled subanalyses from two RCTs and one uncontrolled study (Table S7; see Supporting Information) . The PASI 75 response rates in patients who had achieved PASI 75 during 12 weeks of induction treatment with etanercept 50 mg twice weekly were 77% with etanercept 25 mg twice weekly after 12 weeks of maintenance treatment, and 73% with etanercept 50 mg weekly after 38 weeks of maintenance treatment …”

Etanercept use for psoriasis in Taiwan: a case series study

“…The safety of etanercept used concomitantly with conventional systemic therapies has been demonstrated in open‐label and retrospective studies 1,11,12,34,39,40 . In this study, only one patient experienced a serious adverse effect (i.e.…”