Although combination therapy remains a pillar of psoriasis treatment, says an expert who spoke at the South Beach Symposium, improvised topical combinations can yield mixed results.
“Most dermatologists use combination therapy for psoriasis, regardless of whatever treatment they’re giving,” says David M. Pariser, M.D., community faculty member at Eastern Virginia Medical School, Norfolk, Va.
“Even the new biologics, which have extremely high efficacy, still don’t give everybody 100% clearance,” he adds. Therefore, most patients need spot therapy with topical steroids, calcineurin inhibitors or sometimes localized phototherapy.
Guidelines from both the American Academy of Dermatology and the National Psoriasis Foundation support combination therapy for psoriasis. Accordingly, says Dr. Pariser, dermatologists often combine multiple topical agents on their own, and have been doing so for many years. However, he says, extemporaneous compounding of topical agents may not necessarily yield what dermatologists anticipate.
“When you combine something 50-50 with another product,” he explains, “you’re diluting each one in half. So the efficacy may not be what you expect. Also, in extemporaneously compounded combination products, one is not really sure about whether the vehicle that the product is suspended in is the best vehicle for that particular product.”
Dr. Pariser is a current or previous investigator and/or consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, LEO Pharma, Merck, Novartis, Ortho Dermatologics, Pfizer, Promius and Sun Pharma.
David M Pariser MD. “Combination Therapy in Managing Psoriasis Patients.” South Beach Symposium. February 8, 2020.