Priority 14 from the Psoriasis PSP

UNCERTAINTY: Can oral and biological treatments for psoriasis be combined safely and does combining them work well? (JLA PSP Priority 14)
Overall ranking 14
JLA question ID 0072/14
Explanatory note Not available for this PSP
Evidence

Armstrong, 2015 Some evidence presented to support use of combination therapy (biological with systemic therapies) in selected patients to increase efficacy while minimising toxicity.  Rigorously conducted trials and observational studies evaluating efficacy and safety of combination therapy needed. 

Van Bezooijen – Letter.  Review of methotrexate in combination with biological therapy.  Significant limitations documented.  Recommendation made for adequately powered RCTs to compare biologic monotherapy with biologic / MTX combination therapy.  Short and long term follow up needed to assess clinical outcomes, safety and drug survival.

Zweegers, 2016 Summary of real-world evidence, including 32 studies, on effectiveness of biologics and systemics presented.  Limited data on combination (biologic and systemic) therapy.  Limited comparative data.  Recommendation made to improve quality of reporting and where further work to investigate treatments is needed. 
Health Research Classification System category Skin
Extra information provided by this PSP
Original uncertainty examples Combination therapy in an era with increasing choice of therapeutics
Submitted by 3 uncertainties were submitted around this question
PSP information
PSP unique ID 0072
PSP name Psoriasis
Total number of uncertainties identified by this PSP. 55  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 17 September 2018