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

Abstract

Combination of systemic biological and traditional agents is increasingly used for the treatment of “high-need” patients with psoriasis. There are only limited data on the combination of cyclosporine (CsA) with biologicals. We report our experience concerning the use of etanercept in combination with CsA, given at a dose of 3–5mg/kg two days per week, in patients with insufficient response of psoriasisto etanercept monotherapy. The retrospective analysis of 17 patients showed that the addition of CsA for 2–8 months was capable of inducing a relevant clinical benefit in a total of 12 patients. The combination treatment was tolerated by all patients except one who had to stop CsA treatment because of repeated hypertensive crises.

IL-36 Receptor Antagonist with Special Emphasis on IL-38

“…During the past several years many papers have described a key role for IL-36 in psoriasis which is overexpressed in the skin of human plaque psoriasis (17)(18)(19). The inhibition of IL-36 with IL-36RA in human psoriatic skin has been found to ameliorate the inflammatory reactions (20)(21)(22)(23). It has been shown that IL-22, IL-17A, and TNF-a induce the ex vivo production of all three IL-36 by human keratinocytes, whereas IFN-y selectively induces IL-36P (24)(25)(26).…”

Combination therapy of infliximab and ciclosporin in the treatment of recalcitrant psoriasis: a case series

“…In fact, data from recent European reports indicate that biological therapy is given concomitantly with traditional systemic drugs in up to 30% of patients with psoriasis . Combination therapy of ciclosporin A with biological drugs, particularly etanercept and adalimumab, has been rarely reported in the literature, including in nonrandomized trials and case reports . However, in a review of the literature we found no studies reporting combination therapy of ciclosporin A and infliximab, except for short overlapping periods during switching or sequential therapy…”

Efficacy of etanercept for the treatment of psoriasis: an overview of the Italian clinical experience from the real-life setting and independent studies

“…(15) A retrospective analysis in a small series of patients with unsatisfactory response to etanercept monotherapy reported a meaningful improvement of psoriasis thanks to the addition of cyclosporine, 3-5 mg/kg for two days per week, to etanercept. (22) Short-term addition of narrow-band ultraviolet B phototherapy appears to potentiate and accelerate the therapeutic activity of etanercept, as demonstrated in the single-arm open-label pilot study of De Simone et al (23) Etanercept monotherapy in peculiar forms of psoriasis (Table 3) Prior to the publication of the pivotal randomized placebo-controlled study of etanercept treatment in childhood psoriasis, (24) Papoutsaki et al described the excellent results obtained with etanercept 0.4 mg/kg BIW in 4 pediatric patients, one of whom had a pustular erythrodermic generalized psoriasis and another a palmoplantar psoriasis. (25) Two of these patients were safely and successfully controlled with continuous treatment for up to 77 weeks.…”

“…(21) The interesting aspect of this combination strategy relies upon the absence of any potentially deleterious effect on the immunosurveillance thanks to the non-immunosuppressive mode of action of acitretin. (22) Retrospective analysis of 17 pts with an unsatisfactory response of psoriasis to etanercept monotherapy: primary or secondary inefficacy (n = 7), persistence of lesions at critical sites (n = 5), or flare of psoriasis after switch from efalizumab (n = 5). The choice of topical therapies is another way to avoid the risk of potential toxic effects.…”