Treatments

Links to Psoriasis Treatments Humira:   (also known by its generic name adalimumab) is a biologic medication approved in October 2005 by the U.S. Food and Drug Administration (FDA) for the treatment of psoriatic arthritis. In 2008 it was approved for treating psoriasis, and it is also approved for treating rheumatoid arthritis. For more information about biologics as a class of treatment, please see the For more information about biologics as a class of treatment, please see the biologics section. Key features FDA-approved for psoriasis and psoriatic arthritis Patients give themselves an injection under the skin every other week Patients should be screened for latent (hidden) tuberculosis (TB) before taking Humira Long-term side effects still being evaluated How does it work? Humira blocks tumor necrosis factor-alpha (TNFalpha), a chemical "messenger" in the immune system that signals other cells to cause inflammation. There is too much TNF-alpha in the skin of people with psoriasis and the joints of people with certain types of arthritis. TNF-alpha can also lead to increased immune system activity through the activation of immune cells, including T cells. T cells are a type of white blood cell in the body; in psoriasis, once T cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriasis lesions. Humira helps lower the amount of TNF-alpha, thus interrupting the inflammatory cycle of psoriasis and psoriatic arthritis and leading to improvement in symptoms for many people who take it. Who is a candidate? Humira is prescribed for people with moderate to severe psoriasis and active psoriatic arthritis. Who should not take Humira? People with active serious infections or a history of recurrent infections People with a history of heart failure People with multiple sclerosis or other similar types of demyelinating neurologic diseases Children—the medication has not been approved for children Caution is advised for people who experience any numbness or tingling, or have ever had a disease that affects the nervous system. Caution is also advised for the elderly, due to the already increased risk of infection for this age group. The impact of Humira on pregnant women or developing fetuses is not known, nor is it known if the medication passes into breast milk in nursing women. Humira should only be given to pregnant or nursing women if there is a clear medical need, and if this decision is reached by a patient and doctor together. How is it used? Patients take Humira at home by giving themselves an injection under the skin, similar to diabetes patients who give themselves insulin injections. The recommended dose for patients with psoriatic arthritis is 40 mg every other week. Humira is designed to be taken continuously to maintain improvement. The medication can be prescribed by itself or in combination treatment with methotrexate, a systemic medication prescribed for psoriasis and psoriatic arthritis. In clinical studies, people taking Humira in combination with methotrexate for rheumatoid arthritis experienced more disease improvement than patients taking Humira or methotrexate alone. It is also safe to take Humira with pain relievers, such as NSAIDs, that are often taken for arthritis. Neoral: (cyclosporin) Psoriasis is affected by the immune system. It is thought that T cells over-react to a stimulus Psoriasis conditions, causing the scaling and inflammation of the skin. Cyclosporin can be used in severely disabling and resistant forms of these conditions to suppress the action of the T cells and therefore improve the scaling of the skin.  Cyclosporine (brand name Neoral) is a prescription systemic medication used to treat psoriasis. It has been available since 1995 to help prevent organ rejection in transplant patients. It can be taken by adult patients with severe, difficult-to-treat psoriasis. In 1997, the U.S. Food and Drug Administration (FDA) approved Cyclosporine as a psoriasis treatment. PUVA: A key treatment for psoriasis is PUVA which stands for psoralen (P) + ultraviolet A (UVA). A person is first given psoralens (drugs containing chemicals that react with ultraviolet light) and then exposed to UVA light. This treatment is very effective but elevates the risk of skin cancer. Why has not been known. New Finding: There is an increased prevalence of the human papillomavirus (HPV) in hairs plucked from patients with psoriasis treated with PUVA. HPV is tumorigenic (it causes the formation of tumors).     Comments: This is an important new finding because psoriasis is common and PUVA is a key treatment for it. The idea is that PUVA promotes skin cancer by increasing HPV in the skin. PUVA may do this by stimulating the replication of the virus or by immune suppression, or both. Amevive: Alefacept is an injectable drug that suppresses the immune system and is used for the treatment of psoriasis. Scientists believe that psoriasis is caused by an increase in the production of one type of immune cell, T-lymphocytes, in response to the attachment of a stimulant (antigen) to the lymphocyte. The stimulated T-lymphocytes cause skin cells to grow rapidly, and the rapid growth of the skin cells produces the skin plaques of psoriasis. Alefacept reduces the stimulation and production of T-lymphocytes by attaching to the site on the T-lymphocytes where the antigen attaches. This prevents the antigen from binding and activating the T-lymphocytes. Alefacept also decreases the life-span of T-lymphocytes that already have been produced by increasing the activity of another type of immune cell, natural killer cells, that kill T-lymphocytes. Alefacept was approved by the FDA in January, 2003.  Enbrel:  ENBREL can dramatically reduce psoriasis symptoms Imagine, clearer skin, month after month. If you have psoriasis, a recent medical breakthrough could make this a reality for you, because ENBREL has now been approved for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Many people have seen dramatic improvements while taking ENBREL, and it could make a big difference for you, too. ENBREL can start working fast—and keep working ENBREL can help you stay clearer, month after month. In medical studies, psoriasis patients saw significant results: 3 out of 4 psoriasis patients who took ENBREL had at least a 50% improvement in skin symptoms after 3 months of treatment. What’s more, almost half of the patients studied had at least a 75% improvement. Nearly half of the psoriasis patients studied were determined to be clear or almost clear by 3 months (based on a five-point scale on which 0 = "clear" and 1 = "almost clear"). Improvement was seen in many psoriasis patients as early as 4 weeks. Methotrexate: is a folic acid derivative and a folic acid antagonist. Methotrexate counteracts and competes with folic acid in cells. This blocks DNA synthesis and stops the growth of rapidly dividing cells, causing cell death. MTX works best on extensive psoriasis, erythrodermic and acute pustular psoriasis, physically disabling psoriasis of the palms and soles, psoriasis in the elderly, and severe psoriatic arthritis. The majority of patients achieve significant or even complete clearing of their disease with MTX. The clearance or remission can last for a few weeks to a year or more after stopping therapy. MTX can be highly effective in reducing symptoms of psoriatic arthritis and arresting joint destruction caused by certain forms of psoriatic arthritis. MTX can be taken either by mouth or by injection. The most common way people take MTX is by mouth, either as a pill or in a liquid form. The physician will gradually adjust the dose to the smallest amount needed to achieve clearance. This minimizes the possibility of the patient experiencing side effects. MTX is usually taken in a single dose once a week. The physician will not increase the dose of MTX to achieve total clearing (100 percent) if a few stubborn lesions remain. Instead, another therapy will generally be added, such as UVB, cortisones, or anthralin, to clear the remaining lesions. The physician will perform a number of tests, including kidney and liver tests, to ensure the drug is safely metabolized by the body and is not adversely affecting the liver or bone marrow. If long-term MTX therapy is anticipated, the physician may require a needle biopsy of the liver. The biopsy may be given before or after starting the drug and at intervals while the drug is taken. The initial liver biopsy may be postponed for several months after MTX therapy has begun. This is to avoid an unnecessary procedure in case MTX therapy is stopped for any reason in a short period of time. Reasons for stopping MTX would include lack of patient response, unacceptable side effects, or rapid response not requiring any additional drug.