With the massive amounts of information about psoriasis today, it can be intimidating to try and keep abreast of not only new treatments, but their pros and cons.
Without this information, you cannot really make an informed decision about what to discuss with your doctor and what direction you might want to explore in your attempt to control your psoriasis symptoms. One of the newest groups of medicines are biologics, systemic medications (taken orally or injected).
The Latest and Greatest:
Patients with moderate to sever plaque psoriasis have new treatment options, recently approved by the U.S. Food and Drug Administration: alefacept, efalizumab, and etanercept. One of these, etanercept has also received approval for treatment of psoriatic arthritis, giving new hope to these sufferers as well. The new biologics have been projected to be safer than other, older systemic medications, mainly the kidney or liver failure that long-term use of the older medications can cause.
New injected psoriasis treatments include:
1. Alefacept. The original standard treatment of 12 weeks seems to be more effective with longer remission periods when treatment is administered for a longer period of 16 weeks. Side effects (mild and include infections, injection site reactions, itching, and flu like symptoms) show no significant increase with the longer period versus the standard time table. Repeated courses of alefacept seem to be proving safe and effective as well. Aside from the treatment of plaque psoriasis, this medication seems to be effective on palmoplantar psoriasis after 12 weeks of treatment, allowing the patients to walk without pain and use their hands again. It is also safe to begin alefacept treatment while weaning other therapies.
2. Efalizumab. In studies, this psoriasis treatment has shown to be safe and effective for continuous treatment for up to 60 weeks without fear of toxicity. No new side effects were manifested, while the side effects reported in shorter treatment periods did not worsen. These side effects include: headache, chills, fever, and nausea.
3. Etanercept. This biologic treatment for both plaque psoriasis and psoriatic arthritis has been used to treat rheumatoid arthritis and has shown to be safe on long term treatment of these patients. An important factor to note is that there seems to be relapse within three months after discontinuing use in psoriasis treatment although withdrawal does not cause a severe flare of symptoms. Reinstatement of treatment is still as effective without increase in side effects. Unlike treatment methods with Etanercept for rheumatoid arthritis, psoriasis treatment is suggested to be intermittent or rotated with other treatments.
New oral psoriasis treatments include:
1. Fumaric Acid Ester Therapy. Introduced almost 30 years ago, this is one of Germanys most commonly prescribed oral treatments for sever plaque psoriasis. Common side effects include: flushing, diarrhea, abdominal pain, and nausea. Kidney disorders, decreased white blood cell count, and osteoporosis are more serious side effects of this psoriatic treatment. The gastrointestinal side effects have caused 37% of people taking the original medication to discontinue use; however, recent reformulation offers only rare reports of the gastrointestinal side effects.
2. Oral Pimecrolimus. This psoriasis treatment is two pronged, with both incredible results and a terrifying possible side effect. 2003 studies of the drug treatment showed repeated results in completely clearing symptoms of psoriasis within 28 days, fabulous news for psoriasis sufferers. In June 2006, the FDA released a statement relaying the possibility of a dose dependant connection between oral pimecrolimus and lymphoma. This is based on animal studies which were begun as a result of 10 human cases of patients after beginning this treatment. It has yet to be determined whether this is a direct correlation or not and it may take 10 or more years of human studies to determine whether there is a link between this psoriatic treatment and carcinoma. Due to these findings, the FDA has issued these guidelines concerning the use of this treatment:
A. Use only as second line agent for short term and intermittent treatment in patients unresponsive to, or intolerant of other treatments.
B. Avoid use in children younger than 2 years of age. The effect on the developing immune system in infants and children is not known. In clinical studies, infants and children younger than 2 years old treated had a higher rate of upper respiratory infections than those treated with placebo cream.
C. Use only for short periods of time, not continuously.
D. Do not use in patients with a weakened or compromised immune system.
E. Use the minimum amount needed to control the patients symptoms.
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