adalimumab + etanercept + infliximab + secukinumab

This is a combination of four biologic drugs—adalimumab, etanercept, infliximab, and secukinumab—all of which are monoclonal antibodies or fusion proteins used primarily in the treatment of autoimmune diseases such as psoriasis and psoriatic arthritis. Adalimumab, etanercept, and infliximab are tumor necrosis factor alpha (TNF-α) inhibitors that work by binding to TNF-α and blocking its inflammatory effects. Secukinumab is an interleukin-17A (IL-17A) inhibitor that blocks the activity of IL-17A to reduce inflammation. Each drug targets different but related pathways in immune-mediated inflammatory diseases. There is no evidence from current clinical guidelines or literature supporting the use of all four agents together as a single combination therapy due to overlapping mechanisms and increased risk for immunosuppression; however, each has been studied individually or in dual combinations with other systemic agents for conditions like psoriasis and psoriatic arthritis[2][4][5][8].