title: Combination immunosuppressive therapies: the promise and the peril.
abstract: BACKGROUND
  Targeted immunotherapeutic agents (TIs), also known as biological agents, are efficacious treatments for many immunologically mediated disorders, including psoriasis. In several of these diseases, including rheumatoid arthritis, Crohn's disease, and multiple sclerosis, certain TIs have been studied in combination with nonspecific immunosuppressive agents and with other TIs.
  
  
  METHODS
  Recently, the rheumatology, neurology, and gastroenterology literature has reported several examples of possible associated toxic effects when certain TIs are used in combination with other immunosuppressive agents. These toxic effects have included an increased risk of infection and malignancy.
  
  
  CONCLUSIONS
  Combination therapies are often used by dermatologists. Several TIs have been approved for psoriasis; however, clinical trials using these drugs in combination with other immunosuppressive agents have not yet been performed. The implications for dermatologists of the toxic effects associated with TI combination therapy are unclear. However, combination therapy with certain TIs should be used with caution until more data are available.
authors: Department of Dermatology, University Hospitals Case Medical Center, Murdough Family Center for Psoriasis, Cleveland, Ohio 44106, USA.
authors: Maria R
authors: MR
authors: Robinson
authors: Benjamin D
authors: BD
authors: Korman
authors: Neil J
authors: NJ
authors: Korman
mesh_terms: D004359:Drug Therapy, Combination; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D011565:Psoriasis / Q000188:drug therapy; D018570:Risk Assessment
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents