Effects of maxacalcitol ointment on skin lesions in patients with psoriasis receiving treatment with adalimumab

Abstract

Adalimumab is a biologic that is very effective for treatment of psoriasis. However, recalcitrant or recurrent lesions sometimes occur during treatment. Maxacalcitol is an active vitamin D3 ointment that is effective in treatment of psoriasis. Topical therapy may be beneficial in treatment of recalcitrant or recurrent lesions during treatment with systemic therapy, but there is little evidence on this topic. We investigated the effect of maxacalcitol on skin lesions during treatment with adalimumab in patients with psoriasis. Twelve patients with psoriasis were randomly assigned to two groups after informed consent - treatment with adalimumab only (n = 6), and treatment with adalimumab and maxacalcitol (n = 6) - and they were evaluated every 4 weeks for 44 weeks. Exacerbation was defined as an increase of the Psoriasis Area and Severity Index (PASI) score. The interval between adalimumab treatments was elongated to 3-4 weeks from 2 weeks according to the individual patient's condition. The PASI score was evaluated every 4 weeks, and the frequency of exacerbations was counted. The overall improvement in PASI score was not statistically different between the two groups, but the frequency of exacerbations was significantly less in the maxacalcitol combination group compared with the adalimumab monotherapy group (Mann-Whitney U-test, P < 0.05). The better control of skin lesions in patients who elongated the interval of adalimumab administration was achieved in the maxacalcitol combination group compared with the adalimumab monotherapy group. Topical maxacalcitol treatment is effective and useful in controlling skin lesions in patients with psoriasis when used in combination with adalimumab.

Beyond-Mild Psoriasis: A Consensus Statement on Calcipotriol and Betamethasone Dipropionate Foam for the Topical Treatment of Adult Patients

“…These results are consistent with findings from the Danish DERMBIO registry, which reported that the efficacy of biologics diminishes over time and that this reduced efficacy is responsible for the majority of patient discontinuations [53]. Finally, add-on topical treatment with biologics may also be used to enhance treatment outcomes for patients experiencing secondary loss of efficacy or a seasonal fluctuation/flare/ exacerbation of their disease while receiving a biologic [54].…”

Open-Label, Observational Pilot Study Evaluating Desoximetasone Topical Spray 0.25% Twice Daily in Patients With Psoriasis Being Treated With Biologic Agents

“…However, the frequency of exacerbations was significantly reduced in the combination therapy group. 14 We present the findings of a 2-phase, single-center, openlabel observational study of the efficacy and safety of, as well as patient satisfaction with, desoximetasone topical spray 0.25% (Topicort Spray 0.25%; Taro Pharmaceuticals, Inc, Hawthorne, New York) in combination with biologic agents for the treatment of moderate to severe plaque psoriasis.…”

“…However, the frequency of exacerbations was significantly reduced in the combination therapy group. 14…”

Autoimmunity and autoimmune co‐morbidities in psoriasis

“…The accelerated TNF‐ α /IL‐23/IL‐17 axis coincides with the characteristic histopathology of psoriasis, such as epidermal hyperproliferation, aberrant differentiation and neutrophilic microabscess. Regarding treatments, topical application of steroids and vitamin D3 analogues inhibits psoriatic inflammation and normalizes epidermal differentiation . Systemic treatments, such as cyclosporine, methotrexate and the phosphodiesterase 4 inhibitor apremilast, are useful for patients with extensive lesions .…”

“…Regarding treatments, topical application of steroids and vitamin D3 analogues inhibits psoriatic inflammation and normalizes epidermal differentiation. [61][62][63][64][65] Systemic treatments, such as cyclosporine, methotrexate and the phosphodiesterase 4 inhibitor apremilast, are useful for patients with extensive lesions. [66][67][68] Clinical trials have demonstrated the efficacy of the oral janus kinase inhibitor tofacitinib for psoriasis.…”