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A Psoriasis Treatment Showdown: Mono vs. Combination Therapy


When it comes to treating psoriasis, therapy choice depends on many nuanced factors including disease severity, patient and clinician preference, and insurance status. However, new clinical trails have suggested that combination treatment vs mono-therapy may be most ideal in terms of efficiency and tolerability for psoriasis treatment. 


Reported to be the first of its kind, a new meta-analysis of trials comparing combination therapy vs mono-therapy provides information on the efficiency of combination psoriasis treatment. 


A Snapshot of the Meta-Analysis Study

Dr. April Armstrong and her colleagues from the University of California, Davis noted results from clinical trials pointing to the effectiveness of combination therapy.  Prior to this, the researchers had not seen–to their knowledge–any other comprehensive studies that compiled data on various therapy efficiencies. 

Fifty trials were analyzed for study of clearance efficiency, involving more than 8300 patients.  Ten trials were analyzed for mean difference in clinical severity from mono-therapy treatment vs combinations.  This portion included 1728 patients.


Results of Meta-Analysis

Based off of the analysis of these studies, authors reported results which suggest combination therapies are far more effective treatment versus simply topical mono-therapy.  Instead, the research team saw decreased disease severity when phototherapy was added to a topical regimen.


Examples of Combination Superiority 

+ Using corticosteroids (class I, II or II) showed positive heterogeneity

+ Vitamin D-corticosteroid combination therapy vs corticosteroid monotherapy: 22% increased likelihood of clearance

+ Vitamin D–UV-B combination therapy vs UV-B monotherapy shows no significant increase of clearance in most studies, however, in 2 studies the combination increased clearance by 34% in comparison with monotherapy

+ Vitamin A–psoralen–UV-A  combination therapy vs psoralen–UV-A monotherapy: 22% increased likelihood of clearance as shown in 265 patients from 7 trials

+ 50% increased likelihood of clearance with combination therapy for treatment of palmoplantar pustulosis and hyperkeratotic psoriasis of the hands and feet

+ Vitamin A–psoralen–UV-A combination therapy shows 47% increased clearance efficiency when compared to vitamin A monotherapy 


Source: Medscape Education

[Image by: Franco Folini]

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