For these patients, choice of systemic therapy has to be individualized and payer considerations come into play. The three main conventional go to agents for psoriasis are methotrexate, acitretin, and cyclosporine, which are not interchangeable. Methotrexate is a mainstay agent, and many payers require it be used prior to biologic therapy. In the 1990s and early 2000s, psoriasis was known as a disease mediated by IL-12 and T-helper (Th) 1 cells, which brought into consideration treatments such as alefacept, efalizumab, and TNF-a blockers. Psoriasis is a ubiquitous chronic inflammatory skin disease that occurs most often in adults, with men and women affected with equal prevalence. KEYWORDS: Psoriasis, primary care, corticosteroids, vitamin D analogues, retinoids, phototherapy, laser therapy, methotrexate, acitretin, apremilast, biologic therapies. Before the development of more recent therapies, cyclosporine had been used for the treatment of severe, acute psoriasis in doses of 2. Psoriasis is a chronic immune-mediated inflammatory skin disease commonly categorized as mild, moderate, or severe. Moderate-to-severe psoriasis is associated with significant comorbidity and has been shown to severely impair quality of life. The treatments available include topical drugs, phototherapy, systemic drugs such as methotrexate and, more recently, biological drugs. Although costs of biologics are higher, adherence rates are better and patients require fewer hospitalizations with biologic therapy versus non-biologics; a longitudinal cohort study of 186 patients with psoriasis in the US showed that adherence rates were 0.
Transition from conventional systemic therapy to a biologic agent, either directly or with an overlap if transitioning is needed due to lack of efficacy, or with a treatment-free interval if transitioning is needed for safety reasons. This is supported by the successful treatment of psoriasis with immune-mediating, biologic medications. Some of the newer drugs used to treat severe psoriasis directly modify the function of lymphocytes. Severe diseaseSevere psoriasis requires phototherapy or systemic therapies such as retinoids, methotrexate, cyclosporine, apremilast, or biologic immune modifying agents. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab, the anti-interleukin (IL)-12/23 antibody ustekinumab, and the anti-IL-17 antibody secukinumab. Treatment options for moderate to severe psoriasis include topical and systemic medications, phototherapy, and excimer laser. Biologic drugs that target the root of the disease, the immune system, are the newest therapies considered in the treatment of psoriasis. Combining topical retinoids with other psoriasis treatments, such as topical steroids, works better than using the drug by itself. Apremilast.
The use of biologic therapies, typically reserved for severe disease, is becoming more frequent because of their improved efficacy and adverse effect profiles. (UV) light and, in fact, phototherapy is a commonly used treatment for the disease. For moderate to severe cases, oral agents such as methotrexate, cyclosporine, and calcineurin inhibitors may be prescribed. Biologic therapies are immune modulating agents produced in vitro through recombinant DNA technology. Topical retinoids: Prescription retinoids such as Tazorac (active ingredient tazarotene) have been shown to have a positive effect on plaque psoriasis, particularly in combination with other treatments. Methotrexate: Methotrexate is an immune-modulating drug known for its ability to reduce the uncontrolled overproduction of cells. Drug Treatments in Psoriasis Authors: David Gravette, Pharm. These immune responses allow for many drugs which act as suppressors of immune processes to be effective in the treatment of psoriasis.
Psoriasis vulgaris (chronic stationary psoriasis, plaque-like psoriasis). Light therapy (phototherapy). There may be fever and systemic symptoms such as anorexia and nausea. That work initially pointed towards a major role of T lymphocytes as inducers of the disease phenotype and the pathogenic contribution of this cell type has now been tested through clinical studies of more than a dozen immune modifying biological agents in patients with psoriasis. These immune-biologics provide hope for safe and effective long-term management. Acitretin is a second generation retinoid used in the treatment of psoriasis. The immune mechanisms that mediate scalp psoriasis were found to be similar to those involved in skin psoriasis. Expert Opin Investig Drugs. As there is an overlap in treatments, guttate psoriasis, inverse psoriasis, and impetigo herpetiformis will be discussed under Management strategy’ below. In those with more than 10 body surface involvement, topical therapy may be impractical for all lesions but may provide a useful adjunct to phototherapy or systemic therapy. UVB or PUVA is often combined with oral retinoids or methotrexate, thereby minimizing the number of treatments and the toxicity of each of the therapies.