Psoriasis
— an autoimmune condition that causes itchy, scaly red patches on the skin —
can be tough to treat, and your treatment needs can change over time. When
psoriasis doesn’t respond to topical ointments and light therapy, your
condition may need a different type of medication. That’s when it's likely time
to talk to your doctor about effective prescription treatment options for
moderate to severe psoriasis. The two main types of drugs for psoriasis are
called systemic and biologic.
Systemic drugs affect the entire immune
system, hence the name “systemic.” You typically take them in liquid or pill
form, although some may be given by injection. If you haven't had success with
topical medications or light therapy, or if you have psoriatic arthritis,
you're a potential candidate for systemic drugs. Systemic medications work by
suppressing the immune system to reduce or stop the inflammation that causes
psoriasis. Different types of systemic drugs perform in different ways. Acitretin, for example, works by
slowing down how quickly skin cells multiply. Methotrexate works by interfering with DNA, slowing down the
production of new cells.
Biologic drugs are made from living cells
in a laboratory, meaning they are genetically engineered. Instead of affecting
the entire immune system, biologic medications target specific proteins or
cells, such as tumor necrosis factor alpha (TNF-alpha), interleukin 17-A, or
interleukins 12 and 23 that have a direct connection to psoriasis. This class
of drugs is typically prescribed when other treatments have failed.
“Biologic” Treatment Indications:
·
If no response to classical systemic treatments is seen or their usage
is contraindicated.
·
The PASI (psoriasis area severity index) of at least 15.
Here’s A Concise Review Of
Short Term Response Rates From Literature Review
Adalimumab:
70%
of treated individuals achieve an improvement of PASI 70
45%
of treated individuals achieve an improvement of PASI 90
In
both cases, the dosage is of 40mg every 2 weeks, after an induction dose of 80mg
Etanercept:
35%
of treated individuals achieve an improvement of PASI 70 and 10% have an
improvement of PASI 90 after a dosage of 2 times 25mg per week.
50%
of treated individuals achieve an improvement of PASI 70 and 20% have an
improvemnet of PASI 90 after a dosage of 2 times 50mg per week.
Infliximab
With
a dosage of 0.5mg/Kg at weeks 2, 4 and 6
80%
of treated individuals achieve an improvement of PASI 70.
40%
of treated individuals achieve an improvement of PASI 90.
Ustekinumab
With
a dosage of 45mg every three months:
70%
of treated individuals achieve an improvement of PASI 70.
40%
of treated individuals achieve an improvement of PASI 90.
To
summarize, infliximab achieves the fastest results but it requires an
intravenous infusion every 6 weeks. With ustekinumab, the improvement of PASI
90 is maintained 76 weeks after initiation of treatment in 63% of patients at a
dosage of 90mg and in 45% of patients at a dosage of 45mg. Adalimumab also
remains efficacous 2 years after initiation of treatment.
Which one to chose: adalimumab (anti-TNF),
infliximab (anti-TNF), etanercept (anti-TNF), ustekinumab (anti IL-12): Actually
no real guidelines exist. Personal experience is therefore a must.
New
biologics recently entering the market:
Secukinumab:
With
a dose of 300mg or 150mg given weekly for 5 weeks and then every 4 weeks at 12
weeks
81.5%
of treated individuals with 300 mg achieve an improvement of PASI 75.
71.5%
of treated individuals with 150 mg achieve an improvement of PASI 75.
Therapeutic advise according
to the histological characteristics
·
Keratolytics for hyperkeratosis
·
2-5% salicylic acid (up to 20% concentration in palar and plantar
locations)
·
Emollients for parakeratosis
·
Anthralin, topical steroids, vitamin D analogues and phototherapy for
psoriasiform hyperplasia
·
Topical steroids, cyclosporin, fumaric acid and biologics for erythema.
The Right Psoriasis
Treatment for You
Psoriasis
treatment isn’t a one-size-fits-all approach. Various individual factors
determine which treatment option may be best for you, including the severity of
your psoriasis, if you have any other medical conditions, and your personal
needs. Your doctor’s preference and your insurance coverage are likely to
factor in as well. Some doctors may be more comfortable prescribing systemic
drugs for psoriasis because they've been around much longer and insurance
coverage for these medications is often better and easier to deal with.
In
any medical decision-making process, the choice of treatment requires careful
consideration of the benefits, risks, and alternatives of the treatments being
considered. There are pros and cons to both psoriasis medication options that
should be explored. Work with your doctor to determine the most effective
psoriasis drug treatment for you.
