Some patients find methotrexate and other older medications difficult to tolerate and stop using them because of side effects such as nausea, hair thinning or liver problems, Gelfand explained.
In the research, three biologics and phototherapy were compared with methotrexate, an immunosuppressant also used in cancer treatment.
The study included 713 patients, almost equally divided among men and women, who were rated once for severity of the condition during a regularly scheduled appointment for treatment of psoriasis. Those who had a clear or almost clear skin assessment ranged from 24 percent for methotrexate users to between 34 and 48 percent for the three biologics studied. But, patients on methotrexate had about 3 percent of body surface affected, compared to 2 percent for the biologics, a small difference, said Gelfand.
Biologics can cost $10,000 to $20,000 a year, compared to a couple of thousand dollars for older drugs or phototherapy, said Gelfand.
Phototherapy was found to be about as effective as methotrexate, but is inconvenient because patients must see a doctor three times a week for three months to obtain the recommended dosage, and patients often don't comply with the regimen, Gelfand noted.
On self-assessments, patients found no significant differences among the treatments.
In contrast to the study, another expert on psoriasis said the newer drugs represent a real breakthrough.
Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City, said biologics have worked better for many of her patients and have had fewer side effects. The drugs "give patients hope where there was no hope before," she said.
"In an otherwise healthy patient, if the patient has no infections, no TB [tuberculosis] and is not immuno-compromised, the risk with the biologics is low," she said.
Phototherapy poses a risk of skin cancer for
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