[Transition of classical systemic treatments to etanercept]

The transition of classical systemic treatments to etanercept is an attractive strategy and is, a priori, useful in many clinical practice situations. However, the experience published in this regards has been limited to isolated cases and small series. Transition between methotrexate and etanercept seems to be safe and effective. It should be slowly introduced until etanercept has achieved a sufficient response (4-8 weeks). It even would be possible to try to adjust a long-term combination of low doses of methotrexate. The strategy would be similar for acitretine, the adverse effects characteristic of acitretine being its limitation. Transition from narrow band phototherapy or cyclosporine is, based on the existing experience, effective, although it should be limited to certain moments of the disease due to the uncertainty of the long-term safety of these associations.