title: Combination of adalimumab with traditional systemic antipsoriatic drugs - a report of 39 cases.
abstract: BACKGROUND
  Monotherapy with TNF-α inhibitors does not always produce a sufficient response in psoriasis patients. Combinations of TNF-α antagonists such as adalimumab with systemic antipsoriatic therapies such as methotrexate are not approved for use in psoriasis, and the published data are scarce.
  
  
  METHODS
  The charts of 39 psoriasis patients from 6 dermatology departments were reviewed retrospectively. All patients were given adalimumbab with another systemic antipsoriatic drug.
  
  
  RESULTS
  Combination therapy with methotrexate was most common (n = 32), followed by acitretin (n = 4) and cyclosporine (n = 3). Combination therapy with methotrexate lasted 10.8 ± 11.2 months (mean), with cyclosporine for 6.8 ± 3.3 months, and with acitretin 12.9 ± 12.4 months. Combinations were effective in the majority of patients: 30/39 (76.9 %) had a good (n = 9) or excellent (n = 21) response. Two patients had a moderate response and 7 patients had a poor response and were switched to another treatment. Overall, safety was very good. Eighteen patients experienced 24 adverse events; none was severe and/or required hospitalization. Of these, 10/24 adverse events were infections, most often infections of the upper respiratory tract (n = 5), bronchitis (n = 2), and influenza (n = 1).
  
  
  CONCLUSIONS
  Combinations of adalimumab with traditional systemic antipsoriatic treatments offer a promising method for managing severe or recalcitrant psoriasis. More data are needed to determine the long-term safety and efficacy of these combinations.
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology, Venereology and Allergy, Berlin, Germany. sandra.philipp@charite.de
authors.forename: Sandra
authors.initials: S
authors.lastname: Philipp
authors.forename: Dagmar
authors.initials: D
authors.lastname: Wilsmann-Theis
authors.forename: Ansgar
authors.initials: A
authors.lastname: Weyergraf
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rotterdam
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Frambach
authors.forename: Sascha
authors.initials: S
authors.lastname: Gerdes
authors.forename: Rotraut
authors.initials: R
authors.lastname: Mössner
mesh_terms: D017255:Acitretin / Q000008:administration & dosage*; D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007641:Keratolytic Agents / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D007641:Keratolytic Agents; D016572:Cyclosporine; D000068879:Adalimumab; D017255:Acitretin; D008727:Methotrexate