In the psoriasis literature, there are overall insufficient data on combining biologics with acitretin, cyclosporine, or a second biologic. A combination of etanercept and methotrexate is more effective than monotherapy with either medication. On the basis of the expert opinion of the Medical Board of the National Psoriasis Foundation, the preferred order for combining a second modality with biologics is a biologic and methotrexate combination, biologic and acitretin combination, and then biologic and phototherapy combination.
According to the 2020 joint guidelines of the American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF), combination therapy with methotrexate and TNF-α inhibitors results in improved efficacy over methotrexate monotherapy for the treatment of psoriasis. Adverse events are slightly more common with the combination therapy, but there is no difference in serious adverse events.
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Cite this: David T. Robles. Skill Checkup: A 32-Year-Old Man With an Acute Flare of Psoriasis - Medscape - May 11, 2022.