THERAPEUTICS BJD British Journal of Dermatology Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis P.G. Calzavara-Pinton, 1 R. Sala, 1 M. Arisi, 1 M.T. Rossi, 1 M. Venturini 1 and B. Ortel 2 1 Department of Dermatology, University of Brescia, Brescia, Italy 2 Department of Dermatology, NorthShore University HealthSystem, Chicago, IL,U.S.A. Correspondence PierGiacomo Calzavara-Pinton. E-mail: fototerapia@spedalicivili.brescia.it Accepted for publication 10 February 2013 Funding source None. Conflicts of interest None declared. DOI 10.1111/bjd.12277 Summary Background Previous investigations have demonstrated that a combination of eta- nercept (ETN) and narrowband ultraviolet B (NB-UVB) phototherapy is more effective than ETN alone. However, it is unclear if this combination is more effective than NB-UVB phototherapy alone. Objectives To evaluate whether the combination of NB-UVB phototherapy with ETN improves the efficacy of ETN alone in the treatment of moderate-to-severe psoriasis. Methods We enrolled 322 consecutive patients with moderate-to-severe plaque- type psoriasis, who were treated with NB-UVB phototherapy as the first-line treatment option. Patients who did not achieve a 75% improvement in Psoriasis Area and Severity Index (PASI 75) were treated with conventional systemic thera- pies for psoriasis. If they were ineligible for these, they were treated with ETN 50 mg twice weekly. If they did not achieve PASI 75 within 12 weeks, NB-UVB phototherapy was added. Results PASI 75 was achieved in 262 patients (814%) treated with NB-UVB phototherapy. Sixteen patients (50%) dropped out for personal reasons and 24 (75%) were treated with at least one of the conventional systemic treatments for psoriasis. Twenty patients (62%) were treated with ETN. The combination regi- men was needed in eight patients (25%) with poor response to both photother- apy and ETN alone. All of these patients achieved PASI 75 and three of them had a complete remission after 146  33 NB-UVB exposures. The combined treat- ment was well tolerated without acute adverse events. Unfortunately, all of these patients relapsed, with PASI > 10 within 28  17 months. Conclusions The combined treatment has a synergistic effect for clearing plaque- type psoriasis previously unresponsive to ETN and NB-UVB phototherapy alone. The clearance rate is very high in a very short time without short-term adverse effects. However, concerns regarding potential cocarcinogenicity remain. There- fore the number of patients who require, and could benefit from, the combined treatment is likely to be small. What’s already known about this topic? • Previous studies have reported that the combination of etanercept (ETN) with nar- rowband ultraviolet B (NB-UVB) improves the therapeutic result in patients with psoriasis who were not satisfactorily responsive to ETN alone administered at dos- ages of 50 mg once or twice weekly. • However, it is unclear if this combination is more effective than NB-UVB photo- therapy alone. © 2013 The Authors BJD © 2013 British Association of Dermatologists 130 British Journal of Dermatology (2013) 169, pp130–136