You will be shown a paragraph from a biomedical research article. Your task is to extract all drug combinations appearing in a specific sentence within in the paragraph. Each drug combination should be assigned to one of the following three categories:

- POS: Indicates a positive interaction between the drugs in the combination; for instance, drugs that have an additive or synergistic effect.
- NEG: Indicates a negative interaction between the drugs in the combination; for instance, combining these drugs might result in adverse side effects, or might reduce their efficacy.
- COMB: Indicates that the drugs are given in combination, but the type of interaction between the drugs cannot be determined based on the provided context.

Please format your answer as a json array. Each entry in the array should itself be an array formatted as [<drug_1>, <drug_2>, ..., <drug_n>, <category>] where <category> is one of the three categories listed above and <drug_1>, ..., <drug_n> are drug names copied verbatim from the input sentence. Different combinations may involve different numbers of drugs; in other words, the `n` in <drug_n> may vary.

As an example, the following output describes two extracted drug combinations; one between two drugs, and one between three drugs:

[["artesunate", "artemether", "COMB"], ["Nifedipine", "Labetalol", "Prazosin", "POS"]]

The paragraph and specific sentence are below. You should only extract relationships expressed in the specific sentence; the paragraph is provided for context.

In your output, return only the json array and no other text. If no drug combinations appear, return an empty array `[]`.

paragraph: Optimizing adalimumab treatment in psoriasis with concomitant methotrexate (OPTIMAP): study protocol for a pragmatic, single-blinded, investigator-initiated randomized controlled trial. The introduction of anti-tumor necrosis factor medications has revolutionized the treatment of psoriasis with achievement of treatment goals (Psoriasis Area and Severity Index score 75, remission) that are not usually met with conventional systemics. Nevertheless, some patients continue to experience persistent disease activity or treatment failure over time. Strategies to optimize treatment outcomes include the use of concomitant methotrexate, which has demonstrated beneficial effects on pharmacokinetics and treatment efficacy in psoriasis and other inflammatory diseases. ### methods This is an investigator-initiated , multicenter randomized controlled trial ( RCT ) designed to compare the combination treatment of adalimumab and methotrexate with adalimumab monotherapy in patients with psoriasis . The primary outcome is adalimumab drug survival at week 49. Other outcomes include improvement in disease severity and quality of life, tolerability, and safety. Moreover, anti-adalimumab antibodies and adalimumab serum concentrations will be measured and correlations between genotypes and clinical outcomes will be assessed. Patient recruitment started in March 2014. Up to now, 36 patients have been randomized. Many more patients have been (pre)screened. A total of 93 patients is desired to meet an adequate sample size. In our experience, the main limitation for recruitment is prior adalimumab therapy and intolerability or toxicity for methotrexate in the past. ### discussion OPTIMAP is the first RCT to examine combination therapy with adalimumab and methotrexate in a psoriasis population. With data derived from this study we expect to provide valuable clinical data on long-term treatment outcomes. These data will be supported by assessment of the impact of concomitant methotrexate on adalimumab pharmacokinetics. Furthermore, the influence of several single nucleotide polymorphisms on adalimumab response will be analyzed in order to support the development of a more personalized approach for this targeted therapy. ### Trial Registration NTR4499 . Registered on 7 April 2014.

sentence: This is an investigator-initiated , multicenter randomized controlled trial ( RCT ) designed to compare the combination treatment of adalimumab and methotrexate with adalimumab monotherapy in patients with psoriasis .
[["adalimumab", "methotrexate", "COMB"]]