Advanced Combination Therapy with Tofacitinib and Biologic Agents for Psoriasis and Psoriatic Arthritis: A Case Series.

Introduction: The treatment of psoriatic disease is frequently complex, and many patients do not respond to the available therapies. While novel therapies like biologics and Janus kinase (JAK) inhibitors have been utilized individually to treat psoriatic disease, limited data are available regarding the effect and potential side effects of combining these agents in treatment. Case Presentations: We present a case series of 6 patients with psoriasis and psoriatic arthritis or inflammatory bowel disease treated with tofacitinib and a biologic (5 treated with IL-23 inhibitors and 1 with an IL-17 inhibitor). All patients had tried multiple treatments prior to initiating combination therapy with tofacitinib and a biologic. Out of the 6 patients, 2 remained on combination therapy, while 4 discontinued either one or both drugs due to lack of response or intolerance. We observed a varying effectiveness of the combination therapy, with an overall positive effect on psoriasis and psoriatic arthritis but no effect on inflammatory bowel disease. No major treatment-emergent adverse events occurred during the combination therapy period. Conclusion: This case series adds to the sparse data on combining biologics and JAK inhibitors for the treatment of psoriatic disease. Advanced combination therapy with a JAK inhibitor and a targeted biologic agent may represent a relevant treatment option in selected cases of treatment-refractory psoriatic disease. However, larger studies are needed to establish the safety and efficacy of this combination.