The addition of an immunosuppressive drug to Stelara (ustekinumab) could restore the response to treatment in psoriasis patients, according to a study titled “Recapturing adequate control of psoriasis by additional immunosuppressive agents alongside ustekinumab,” published in the Journal of the American Academy of Dermatology Case Reports.
A team of researchers from the Royal Liverpool and Broadgreen Hospitals NHS Trust in Liverpool, England, carried out a survey of all psoriasis patients who took immunosuppressive drugs at the same time as Stelara between October 2009 and April 2015.
They report that 76 patients took Stelara during this time to treat their psoriasis. Seven of these patients also required additional immunosuppressive drugs because they were not responding to Stelara. The additional immunosuppressive agents included Droxia (hydroxiurea) used by three patients; Trexall (metothrexate) used by two patients; Imuran (azathioprine) used by one patient; and fumaric acid esters used by one patient. This resulted in the disease being well controlled in five of the patients.
In the remaining two patients who did not respond well to the addition of another immunosuppressive agent on top of Stelara, adequate disease control was achieved only after switching between several different immunosuppressive agents.
The researchers concluded that treatment protocols for psoriasis patients should be developed and could include, first, the addition of an immunosuppressive agent as soon as the effectiveness of a drug starts to plummet or if the presence of antidrug antibodies are found in patients who do not have biologic agents in their blood. Second, the treatment could include the addition of an immunosuppressive drug from the start of treatment in patients who already have biologic agents in their blood.
Psoriasis is a complex autoimmune disease that can be difficult to treat. Although there are several drugs licensed to treat it, these can lose their effectiveness over time. This could be due to the body producing antibodies against the drugs and eventually inactivating them.
Previous studies have shown that psoriasis drugs lost their effectiveness faster in women, smokers, those whose life was more affected by their psoriasis (measured by a higher score in the Dermatology Life Quality Index), and those taking Enbrel (etanercept) or Remicade (infliximab).
But the drugs tended to be effective longer in patients who had psoriatic arthritis and those who were taking Stelara.
