Answer:
Cyclosporine is an immunomodulator that blocks interleukin-2 and is used and approved for psoriasis treatment for up to 1 year of therapy. Etanercept is an anti–tumor necrosis factor (TNF) receptor blocker protein also approved for psoriasis, as well as other indications. The use of the two simultaneously has not been well studied. However, there are times that they can be used together for short periods of overlap if this approach is deemed clinically appropriate. If a patient is flaring, for example, and needs a quick cool down. I would not advocate using these agents together for long periods for multiple reasons. First, cyclosporine is indicated for only 1 year and causes renal impairment in all patients that stay on it longer than that. The package insert for etanercept warns about using other immunosuppressive medicines concurrently with etanercept. I feel that if a patient is not doing well on either one as monotherapy, then other alternatives should be sought. On occasion, combining methotrexate and anti-TNF medicines is a reasonable choice supported by evidence from its use in rheumatoid arthritis. We are lucky to have many biologic choices and systemic therapies; finding one to work for our patients should be easier in the future.

  Ask the Expert Home