Clinical Edge

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Do Patients With Psoriasis Benefit From Combination Systemic Therapy?

Various demographic and socioeconomic factors are associated with the use of combination systemic therapy in psoriasis compared to use of systemic monotherapy, a new study found. The cross-sectional study of patients were enrolled in the Corrona Psoriasis Registry, a prospective multicenter observational disease-based registry with patients recruited from 154 private and academic practice sites in the US and Canada with 373 participating dermatologists. Patients aged ≥18 years who enrolled between April 2015 - March 2017 and initiated biologic therapy at the time of enrollment were included. Researchers found:

  • Patients on combination therapy were more likely to identify as black, to be insured by Medicaid, and to report disabled work status.
  • Patients on combination therapy were more likely to have concomitant psoriatic arthritis.
  • No major differences were observed in disease morphology, duration, IGA, PASI, or BSA affected at treatment initiation.

Citation:

Bonomo L, et al. Combination use of systemic therapies in psoriasis: Baseline characteristics from the Corrona Psoriasis Registry. J Drugs Dermatol. 2019;18(8):731-740.

Commentary:

This is an interesting observation that there was an increased incidence of patients on combination therapy with a biologic agent and an oral systemic agent that were identified as black, having Medicaid coverage, and having disability. It is not surprising that patients with psoriatic arthritis are more likely to be on combination therapy with an agent such as methotrexate since this is the most commonly used combination. Many patients that need combination therapy tend to have recalcitrant psoriasis that frequently relapses with a biologic therapy used as monotherapy. In addition, dermatologists may employ combination therapy to maximize usage of that particular biologic before switching to a different one. —Paul S. Yamauchi, MD, PhD; Clinical Assistant Professor of Dermatology David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center Division of Dermatology; Adjunct Associate Professor John Wayne Cancer Institute.