How Do Systemic Medications Treat Psoriasis?
- When treatments applied to the skins’ surface doesn’t help your psoriasis, your doctor may recommend trying a treatment that travels through your entire body rather than being aimed at one area.
- Systemic treatments are available via oral medication and injections.
- Psoriasis is a chronic disease with no cure, so it’s important to be prepared for the commitment that comes with systemic therapy.
“I have patients who come in after having been to many other medical practices and not really getting much hope or really good treatments for their psoriasis,” Dr. George Han, a dermatologist at Northwell Health/Lenox Hill Hospital, explains to SurvivorNet. “And we’ll give the patient a systemic medicine that these days are very effective. We have treatments where over half of the patients who have moderate to severe psoriasis are getting 100% clear.”
Read MoreOral Medications to Treat Psoriasis
Oral systemic treatments are medicines that are taken by mouth or injection and work throughout the body.- Methotrexate: This medication was approved for psoriasis in 1972, and has been a mainstay of systemic treatment. The medication, which can be administered orally or intravenously, works as an immunosupressant that inhibits rapidly dividing cells. According to the American Academy of Dermatology and National Psoriasis Foundation guidelines, methotrexate is typically administered in doses ranging from 7.5 mg to 25 mg weekly as one dose or divided into three dosages over 24 hours. Common side effects include fatigue and nausea.
- Apremilast (Otezla): This medication works by supressing an enzyme inside inflammation cells. Dr. Khattri notes that apremilast also has an additional indication to treat psoriatic arthritis. The most common side effects are diarrhea, nausea, upper respiratory tract infection and headache.
- Cyclosporine: Due to a host of potential serious adverse effects, this drug isn’t used for long term psoriasis treatment according to the AAD and NPF. But it does have a role “as a rapid-acting medication for severe, recalcitrant disease, acute flares, and erythroderma.” Nephrotoxicity (kidney issues) and hypertension (high blood pressure) are the most common adverse effects of cyclosporine.
Biologics To Treat Psoriasis
Biologic drugs, or biologics, are given by injection or intravenous (IV) infusion (a slow drip of medicine into your vein). While other systemic drugs impact the entire immune system, biologics only target specific parts of the immune system, according to the NPF. The biologics used to treat psoriasis block the action of a specific type of immune cell called a T-cell. Or they block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A or interleukins 12 and 23.
There are several different types of biologics available to treat psoriasis, including:
- TNF-Alfa Inhibitors (Enbrel, Humira, Cimzia, Remicade, and Simponi)
- IL- 17 Inhibitors (Cosentyx, Siliq, and Talz)
- IL-23 Inhibitors (Ilumya, Skyrizi, Tremfya)
- IL12/IL23 Inhibitors (Stelara)
- T-Cell Inhibitors (Orencia)
Dr. Han explains the benefits of each category: “I would say that the attractive things about some of these medicines, for example, the IL-23 inhibitors — some of them are injected as infrequently as once every three months. So that’s nice to be able to offer to somebody…The TNF-alpha inhibitors, the kind of the oldest class, they may block a little more parts of your immune system. So I probably reach for those a little less now. The IL-17 inhibitors are in the middle and they do seem to work very well for both skin and joint disease.”
Dr. Saakshi Khattri, a dermatologist at Mt. Sinai Medical Center, notes that there is a long term commitment with biologics. “It’s not one and done,” she says.
“Psoriasis is a chronic disease these injections are something that you’d have to be on as long as it’s needed or as long as it’s efficacious for you in terms of treating your psoriasis.”
The injection treatment schedules vary by medication. “You have some that are every week, others that are every other week, then you have some that are, are once a month. Uh, some that are once every other month, some that are every three months. So it, they come in different flavors,” she says.
Questions To Ask Your Doctor
- Could a systemic treatment be an option to treat my psoriasis?
- Could I consider treatment with a biologic?
- What are the side effects of systemic treatments for psoriasis?
- Can I use a systemic treatment with a topical treatment?
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