P05 Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis: real-life data from the BiPe cohorts

Abstract

Abstract Combined therapies, defined as treatment modalities involving combinations of two or more drugs, are used with three main aims: to increase the efficacy of each drug; to reduce the toxicity of each drug; and, in some cases, to reduce costs by reducing the required dosages of each treatment. We explored the use of combinations of conventional systemic therapies and biologics in children with psoriasis in daily practice from the 170 children in the Franco–Italian BiPe cohorts to evaluate the use, efficacy and safety of combined conventional systemic–biologic therapies. In total, 33 children (19.4%) from 13 dermatology centres received 48 combined conventional systemic–biologic therapies (cumulative duration 43.6 years), including three triple combination therapies (acitretin–methotrexate, with a TNF-α inhibitor). Fourteen different combinations were used, most frequently etanercept–acitretin (n = 10), adalimumab–acitretin (n = 7), adalimumab–methotrexate (n = 5) and ustekinumab–methotrexate (n = 5). The combined therapies were started at biologic initiation in 41 cases (85.4%), and after a period of biologic monotherapy in the remaining seven cases. Mean PGA and PASI scores decreased between baseline and M3 with all the combinations used. Four serious adverse events were reported, all with favourable outcomes. Combined therapies have been used frequently in the treatment of childhood psoriasis, in a range of clinical situations and in variable drug combinations, without significant toxicity. Although the use of these combined therapies needs to be clarified in future management guidelines, these combined therapies should be considered for the treatment of children with severe psoriasis, psoriatic arthritis and recalcitrant ­disease.