Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks

Type:Uv phototherapy   Time:2014-12-11 15:34:44
Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks.
Gambichler T1, Tigges C, Scola N, Weber J, Skrygan M, Bechara FG, Altmeyer P, Kreuter A.
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Abstract
BACKGROUND:
A substantial portion of patients with psoriasis does not achieve a satisfactory response under antitumour necrosis factor 

(TNF)-¦Á biological therapies.
OBJECTIVES:
We aimed to evaluate whether etanercept plus narrowband ultraviolet B (NB-UVB) phototherapy is superior to etanercept 

monotherapy in the management of psoriasis.
METHODS:
In this prospective study, patients with psoriasis were treated with etanercept 25 mg twice weekly. Two marker lesions were 

selected for determination of the modified Psoriasis Area and Severity Index (M-PASI). NB-UVB was administered thrice weekly 

whereby one marker lesion was covered as nonirradiated control. Skin biopsies for histology and immunohistochemistry were 

performed in both marker lesions after a 6-week treatment course.
RESULTS:
After 6 weeks of therapy, the relative M-PASI reduction (mean ¡À SD) in etanercept-treated sites (53¡¤7 ¡À 36¡¤9%) was 

significantly lower than the reduction in etanercept plus NB-UVB-treated lesions (64 ¡À 27¡¤8%; P = 0¡¤011). At the end of 

treatment, histology scores of etanercept-treated psoriatic plaques were significantly higher than scores of etanercept plus 

NB-UVB-treated sites (4¡¤6 ¡À 2¡¤7 vs. 3¡¤7 ¡À 2¡¤4; P =0¡¤045). Epidermal immunoreactivity for CD1a, CD4 and CD8 was 

significantly lower in etanercept plus NB-UVB-treated lesions when compared with etanercept monotherapy.
CONCLUSIONS:
Etanercept combined with NB-UVB is more effective than etanercept monotherapy at 6 weeks as demonstrated at a clinical, 

histological and immunohistological level. However, as there is an increased risk for malignancy by treatment with TNF-¦Á 

blockers alone or in combination with phototherapy, we recommend to restrict this highly effective combination to short 

periods of time, for instance to obtain a quicker response, and to avoid long-term treatment.
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