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Keywords:

  • 311 nm;
  • combination therapy;
  • etanercept;
  • psoriasis;
  • ultraviolet

Summary

Background  Some patients with plaque-type psoriasis respond slowly to treatment with etanercept. In such cases combining etanercept with conventional treatments might be helpful.

Objectives  To investigate whether treatment with 311-nm ultraviolet (UV) B can improve the therapeutic response in patients treated with etanercept.

Methods  Four women and one man (mean age 57 years, range 48–66) with moderate to severe plaque-type psoriasis who had received standard treatment with etanercept 50 mg twice weekly for 6 weeks without Psoriasis Area and Severity Index (PASI) reduction of 75% or greater (of initial mean PASI of 16·0, range 15·4–20·4) were enrolled in the study. Starting at 6 weeks, 311-nm UVB treatment was given to a randomly selected body half (left or right, excluding the head) for another 6 weeks, while all patients continued receiving etanercept. The patients were monitored by half-body PASI at weekly intervals.

Results  During the 6-week irradiation regimen, 311-nm UVB significantly bolstered the therapeutic response in the patients on etanercept treatment. After 6 weeks of 311-nm UVB, the patients had a mean PASI on their UV-irradiated body halves of 1·6 (range 0·6–3·3) vs. 4·7 (range 1·4–8·6) on nonirradiated body halves (= 0·0192, paired two-tailed t-test), compared with 10·7 (range 6–16·4) and 10·5 (range 5·2–16·4) at start of 311-nm UVB treatment. The overall mean PASI reduction from baseline (i.e. at etanercept start) was 89% vs. 68%, respectively (= 0·0009 and = 0·0088).

Conclusions  Treatment with 311-nm UVB significantly accelerates and improves the clearance of psoriatic lesions in patients responding slowly to etanercept monotherapy.