Combination of antitumour necrosis factor-α and anti-interleukin-12/23 antibodies in refractory psoriasis and psoriatic arthritis: a long-term case-series observational study
Abstract
Combination of an antitumour necrosis factor-α agent and ustekinumab may be beneficial in patients with psoriasis and PsA who do not respond to biologics in monotherapy. However, we noted a higher risk of infectious complications - relapsing herpes zoster (patient 1) and retrotonsillar abscess (patient 2) - which were probably related to the treatment.[10] The relation between infections and biologics in patient 3 is less clear, as this patient had a history of recurrent skin infections.
Importantly, there were no opportunistic infections. To our knowledge this is the first long-term observational study documenting the effects of biologics given in combination for psoriasis.
Cuchacovich et al.[11] described a synergistic effect of ustekinumab and etanercept in a 38-year-old man who was treated for 11 months without any adverse events. Similar to our patients, the main reason for giving the biologics in combinations was differences in drug activity towards cutaneous psoriasis and PsA.[3] The fact that these two classes of antibodies show additive efficacy supports the hypothesis that the immunopathogenesis of the cutaneous and articular manifestations of psoriasis may be dissociated from each other.