Combination therapy for psoriasis in the United States

Abstract

Background: Psoriasis is treated with several classes of treatments that may be used in combination, but the ways combination therapies are used are not well characterized.

Purpose: To determine the frequency of prescribing calcipotriene and other psoriasis drugs in combination.

Methods: Visits with a sole diagnosis of psoriasis were selected from 1990-2010 data from the National Ambulatory Medical Care Survey. The number of combination therapies used, the leading therapies in each class of medications, and the leading types used in combination were analyzed.

Results: About 10.2 million of 20.3 million psoriasis visits used multiple treatments. The mean number of prescribed medications increased over time (P=.0003). The top 10 treatments included 6 topical steroids, calcipotriene, 2 other topicals, and methotrexate. The most common combinations were topical steroid plus other topical (15.0%), multiple topical steroids (11.5%), topical steroid plus vitamin D analogue (9.7%), and topical steroid plus systemic treatment (6.9%). Vitamin D analogues and systemic treatments were prescribed with increasing frequency over time, while fewer topical steroids were used, and use of other topicals did not change significantly.

Limitations: Visits with multiple diagnoses had to be excluded to ensure that the medications listed were for psoriasis.

Conclusions: Combination therapy is the most common way to treat psoriasis in the United States. The wide range of combination therapies prescribed may reflect increased attention to individualization of treatment to match patients' diverse preferences.