Dual biologic therapy for recalcitrant psoriasis and psoriatic arthritis

Numerous biologic medications are available to treat psoriasis and psoriatic arthritis; however, many patients experience differential responses of their skin and joints to the same agent. In patients who do not respond to biologic monotherapy or combination of a biologic with an oral systemic agent, dual biologic therapy is a possible treatment option. Dual biologic therapy is rarely reported in the psoriatic literature (Table I).1-6 We present a patient with severe psoriatic skin and joint disease who has been treated with multiple combinations of dual biologic therapy, including ustekinumab plus etanercept for 12 months, secukinumab plus etanercept for 6 months, and guselkumab plus etanercept for 15 months.