title: Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis.
abstract: BACKGROUND
  Previous investigations have demonstrated that a combination of etanercept (ETN) and narrowband ultraviolet B (NB-UVB) phototherapy is more effective than ETN alone. However, it is unclear if this combination is more effective than NB-UVB phototherapy alone.
  
  
  OBJECTIVE
  To evaluate whether the combination of NB-UVB phototherapy with ETN improves the efficacy of ETN alone in the treatment of moderate-to-severe psoriasis.
  
  
  METHODS
  We enrolled 322 consecutive patients with moderate-to-severe plaque-type psoriasis, who were treated with NB-UVB phototherapy as the first-line treatment option. Patients who did not achieve a 75% improvement in Psoriasis Area and Severity Index (PASI 75) were treated with conventional systemic therapies for psoriasis. If they were ineligible for these, they were treated with ETN 50 mg twice weekly. If they did not achieve PASI 75 within 12 weeks, NB-UVB phototherapy was added.
  
  
  RESULTS
  PASI 75 was achieved in 262 patients (81.4%) treated with NB-UVB phototherapy. Sixteen patients (5.0%) dropped out for personal reasons and 24 (7.5%) were treated with at least one of the conventional systemic treatments for psoriasis. Twenty patients (6.2%) were treated with ETN. The combination regimen was needed in eight patients (2.5%) with poor response to both phototherapy and ETN alone. All of these patients achieved PASI 75 and three of them had a complete remission after 14.6 ± 3.3 NB-UVB exposures. The combined treatment was well tolerated without acute adverse events. Unfortunately, all of these patients relapsed, with PASI > 10 within 2.8 ± 1.7 months.
  
  
  CONCLUSIONS
  The combined treatment has a synergistic effect for clearing plaque-type psoriasis previously unresponsive to ETN and NB-UVB phototherapy alone. The clearance rate is very high in a very short time without short-term adverse effects. However, concerns regarding potential cocarcinogenicity remain. Therefore the number of patients who require, and could benefit from, the combined treatment is likely to be small.
authors.affiliation: Department of Dermatology, University of Brescia, Brescia, Italy. fototerapia@spedalicivili.brescia.it
authors.forename: P G
authors.initials: PG
authors.lastname: Calzavara-Pinton
authors.forename: R
authors.initials: R
authors.lastname: Sala
authors.forename: M
authors.initials: M
authors.lastname: Arisi
authors.forename: M T
authors.initials: MT
authors.lastname: Rossi
authors.forename: M
authors.initials: M
authors.lastname: Venturini
authors.forename: B
authors.initials: B
authors.lastname: Ortel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012008:Recurrence; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept