Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy

Background The antitumour necrosis factor (TNF) activity of etanercept has been utilized to generate an important and novel treatment for rheumatoid arthritis. TNF has also been implicated in the pathogenesis of psoriasis. Objectives To determine whether blockade of TNF activity by etanercept may provide an additional treatment option for patients with psoriasis. Methods In an uncontrolled trial, etanercept was added to the treatment regimen in six patients with severe recalcitrant psoriasis (three also with psoriatic arthritis) partially resistant to other ongoing systemic agents. Results In each case, the disease activity showed marked improvement on addition of etanercept therapy. No added toxicity was found with etanercept. Conclusions Etanercept appears to be a promising immunomodulatory agent that call be used in combination therapy for the treatment of psoriasis, and a prospective controlled trial may be warranted.