Combining Systemic Therapies: Should You Do It?

In this presentation by Carol Buttar, the focus is on the combination of systemic therapies for various autoimmune and skin diseases, particularly connective tissue diseases such as dermatomyositis, lupus, and scleroderma. Buttar emphasizes the complexity of the immunopathogenic mechanisms involved, suggesting that targeting multiple pathways often yields better patient outcomes. For dermatomyositis, she outlines a stepwise treatment approach involving medications like methotrexate, mycophenolate mofetil, and steroids, with options to incorporate IVIG or newer therapies like apremilast and tofacitinib for severe cases. Various studies showcased the effectiveness of these treatments, demonstrating significant improvements with acceptable safety profiles. Buttar also discusses the potential benefits of integrating biologics such as rituximab and new immunotherapies targeting type 1 interferon for conditions like lupus and systemic sclerosis. Ultimately, she advises careful monitoring to manage the increased risk of infections that may arise from combining these therapies. Her key message highlights the necessity of personalized treatment plans, utilizing both established and emerging therapies to improve the quality of life for patients with challenging autoimmune skin conditions.