Journal of Clinical & Experimental Dermatology Research
Open Access
ISSN: 2155-9554
+44 1478 350008
ISSN: 2155-9554
+44 1478 350008
Lauren Bonomo, Alvaro J Rodriguez, Brian Abittan, Ahmad Aleisa and Mark Lebwohl
Icahn School of Medicine at Mount Sinai, USA
Posters & Accepted Abstracts: J Clin Exp Dermatol Res
Background: Treatment of moderate to severe psoriasis or psoriatic arthritis often poses a chal-lenge to the physician. Patients with moderate to severe disease frequently do not respond to initial, non-systemic therapies such as topical medications or phototherapy. The next step in treatment for these patients is initiation of a single-agent systemic therapy. However, systemic monotherapy is often insufficient in attaining the desired level of control, and increasing the dose of many of the first-line medications may pose a safety risk to the patient. As such, combination therapies are frequently used in these difficult cases. There is a paucity of litera-ture related to combination therapies involving newer agents, such as biologic drugs. Initial investigations suggest that biologics in combination with cyclosporine, methotrexate, acitretin, or even an-other biologic are promising options for recalcitrant plaque psoriasis. Methods: In this retrospective chart review, all pa-tients billed with the ICD-10 code L40.0 (psoriasis vulgaris) at a single U.S. tertiary referral center in the past two years were identified. Anonymized data that were collected included sex, year of birth, age at diagnosis, psoriasis type, presence of psoriat-ic arthritis, comorbidities, previous therapies, clini-cal severity before and after combination treatment, and adverse events experienced. Results: Of the 523 patients billed for a diagnosis code of psoriasis in the past two years, there were 47 patients who met inclusion criteria. They repre-sented 60 distinct treatment combinations. The combinations we evaluated were, for the most part, one biologic drug with one traditional oral therapy (Table 1). Despite the severity and history of prior treatment failure in our cohort, 65% of combination regimens elicited at least a 50% response. Only 6% of combinations resulted in no clinical response (defined as less than 25% improvement). While there were no statistically significant differences among the unique combinations, methotrexate in combination with a biologic was the regimen that appeared to produce the best response (p=0.115). Conclusion: We conclude that combination therapy should be considered in patients with recalcitrant psoriasis who have failed multiple single-agent regimens. Our results suggest methotrexate may be particularly effective in combination with a biologic agent.
Lauren Bonomo, BA, graduated with honors from Yale University and is now a Medical student at the Icahn School of Medicine at Mount Sinai. She is currently on a scholarly year, pursuing research in Icahn’s Depart-ment of Dermatology. She is particularly interested in inflammatory and autoimmune skin disease, including atopic dermatitis, psoriasis, vitiligo, and alopecia areata.
Email: lauren.bonomo@icahn.mssm.edu