Combo Therapies in Psoriasis More Effective Than Monotherapy

Adding phototherapy to topical monotherapy improves psoriasis clearance

MONDAY, Dec. 19 (HealthDay News) -- Many combination topical therapies for psoriasis are more effective than topical monotherapies, and adding phototherapy to topical monotherapy generally improves psoriasis clearance, compared to monotherapy alone, according to a meta-analysis published online Dec. 19 in the Archives of Dermatology.

Elizabeth E. Bailey, M.D., M.P.H., from the Brigham and Women's Hospital in Boston, and colleagues reviewed available literature through July 2010 to evaluate the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis. Randomized controlled trials were included in the meta-analysis if data were available regarding the proportion of disease clearance or mean change in clinical severity score for combination treatment efficacy, compared with one or more monotherapies. Data were extracted for clearance, definition of clearance, mean and standard deviations for baseline and final disease symptom scores, and major design characteristics.

The investigators found that, compared to one or more monotherapies, the likelihood of disease clearance was greater with combination regimens of: vitamin D derivative with corticosteroid or ultra violet (UV)-B; vitamin A derivative combined with psoralen-UV-A or corticosteroid or UV-B; and corticosteroid combined with hydrocolloid occlusion dressings, UV-B and alefacept, and vitamins A and D derivatives. Significant sources of heterogeneity between the studies were the blinding status and potency of the corticosteroid treatments used.

"Future research in combination therapy is necessary to devise new therapeutic strategies to maximize efficacy while minimizing adverse effects," the authors write.

One author disclosed financial ties to Amgen, Abbott, and Janssen Biotech, which manufacture psoriasis treatment products.

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