title: Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks.
abstract: BACKGROUND
  A substantial portion of patients with psoriasis does not achieve a satisfactory response under antitumour necrosis factor (TNF)-α biological therapies.
  
  
  OBJECTIVE
  We aimed to evaluate whether etanercept plus narrowband ultraviolet B (NB-UVB) phototherapy is superior to etanercept monotherapy in the management of psoriasis.
  
  
  METHODS
  In this prospective study, patients with psoriasis were treated with etanercept 25 mg twice weekly. Two marker lesions were selected for determination of the modified Psoriasis Area and Severity Index (M-PASI). NB-UVB was administered thrice weekly whereby one marker lesion was covered as nonirradiated control. Skin biopsies for histology and immunohistochemistry were performed in both marker lesions after a 6-week treatment course.
  
  
  RESULTS
  After 6 weeks of therapy, the relative M-PASI reduction (mean ± SD) in etanercept-treated sites (53·7 ± 36·9%) was significantly lower than the reduction in etanercept plus NB-UVB-treated lesions (64 ± 27·8%; P = 0·011). At the end of treatment, histology scores of etanercept-treated psoriatic plaques were significantly higher than scores of etanercept plus NB-UVB-treated sites (4·6 ± 2·7 vs. 3·7 ± 2·4; P =0·045). Epidermal immunoreactivity for CD1a, CD4 and CD8 was significantly lower in etanercept plus NB-UVB-treated lesions when compared with etanercept monotherapy.
  
  
  CONCLUSIONS
  Etanercept combined with NB-UVB is more effective than etanercept monotherapy at 6 weeks as demonstrated at a clinical, histological and immunohistological level. However, as there is an increased risk for malignancy by treatment with TNF-α blockers alone or in combination with phototherapy, we recommend to restrict this highly effective combination to short periods of time, for instance to obtain a quicker response, and to avoid long-term treatment.
authors.affiliation: Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany. t.gambichler@klinikum-bochum.de
authors.forename: T
authors.initials: T
authors.lastname: Gambichler
authors.forename: C
authors.initials: C
authors.lastname: Tigges
authors.forename: N
authors.initials: N
authors.lastname: Scola
authors.forename: J
authors.initials: J
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Skrygan
authors.forename: F G
authors.initials: FG
authors.lastname: Bechara
authors.forename: P
authors.initials: P
authors.lastname: Altmeyer
authors.forename: A
authors.initials: A
authors.lastname: Kreuter
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D018949:Antigens, CD1 / Q000378:metabolism; D002454:Cell Differentiation; D049109:Cell Proliferation; D003131:Combined Modality Therapy / Q000379:methods; D003879:Dermatologic Agents / Q000008:administration & dosage*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*
chemical_list: D018949:Antigens, CD1; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D019394:Ki-67 Antigen; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept