American Academy of Dermatology Issues New Guidelines For the Management of Psoriasis With Systemic M... (ial to minimize the toxicity of any ther...)

American Academy of Dermatology Issues New Guidelines For the Management of Psoriasis With Systemic Medications

Date:6/4/2009

ial to minimize the toxicity of any therapy. For example, the most common and generally minor side effects of methotrexate that most often occur at the time it is administered include nausea, fatigue, inflammation of the mucous membranes of the mouth and anorexia. The most serious toxicities associated with methotrexate are white blood cell and platelet deficiency, liver damage and lung scarring.

Since methotrexate can cause birth defects or terminate a pregnancy, it is not prescribed to women attempting to conceive. In addition, methotrexate should not be prescribed to nursing mothers, those with chronic liver disease, alcoholics, or patients with immunodeficiency syndromes, among others.

Cyclosporine

Cyclosporine is one of the most effective treatments for psoriasis and induces immunosuppresion by inhibiting the first phase of T-cell activation. When the medication is used long-term (i.e., three to five years), a significant number of patients will develop some degree of glomerulosclerosis, scarring of the kidney's blood vessels. For this reason, Dr. Pariser noted that published guidelines in the United States limit the use of cyclosporine to one year.

Efficacy & Dosage

Numerous clinical trials have demonstrated the efficacy of cyclosporine used as a short-term treatment for psoriasis, with minimal toxicities in healthy patients. Specifically, studies show at 3 mg/kg and 5 mg/kg per day, 36 percent and 65 percent of patients, respectively, achieved a clear or almost clear result after eight weeks. In addition, after eight to 16 weeks, 50 to 70 percent of patients achieved a 75 percent or greater improvement in their PASI score. Cyclosporine is generally prescribed to adult, non-immunocompromised patients with severe psoriasis who have not responded to at least one systemic therapy or in patients who cannot tolerate other systemic medications.

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