PsoriasisNet Article
Thinking About Other Ways to Treat Your Psoriasis?
Here’s what the latest research shows

Information about psoriasis treatments seems to be everywhere these days - from magazine articles and chat rooms to billboards and TV ads. Keeping up on the latest findings can be a challenge. To help you reap the benefits of staying current - making informed decisions about your treatment options and getting tips that may make a therapy more effective for you - key findings from recent clinical trials and case reports are summarized below. Much of this focuses on the biologics, a new class of medications being used to treat moderate to severe psoriasis. Recent research also has investigated new oral therapies and expanded existing knowledge of treatments applied to the skin.

What We’re Learning About the Biologics
In less than two years, three biologics - alefacept, efalizumab, and etanercept - were approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults who have moderate to severe plaque psoriasis and are candidates for phototherapy or systemic treatment. Etanercept also has been approved for treating psoriatic arthritis. Clinical trials continue to investigate the use of these medications in treating psoriasis and psoriatic arthritis. Several other biologics also are being studied in clinical trials. Two of these, adalimumab and infliximab, may soon join the list of FDA-approved treatments for psoriasis.

Research efforts are focusing on the biologics because of the potential these medications may have to provide safe and effective long-term treatment. Data shows that the biologics being used to treat psoriasis may have a better safety profile than either cyclosporine or methotrexate - two systemic medications approved for the treatment of moderate to severe psoriasis. None of the biologics has shown the potential to cause the serious kidney or liver problems that limit long-term use of cyclosporine and methotrexate. Here are recent key findings:

• Alefacept: More may be better for chronic plaque psoriasis. Clinical trials continue to study dosing - what is the optimal amount and for how long the medication should be given. Small studies indicate that the effectiveness of alefacept in clearing chronic plaque psoriasis increases when therapy is given once a week for 16 weeks instead of the standard 12 weeks. Patients treated for 16 weeks showed continued improvement, and side effects were similar to those observed in patients taking alefacept for 12 weeks. Side effects tend to be mild and include infections, injection-site reactions, itching, and flu-like symptoms, such as fatigue, chills, nausea, and muscle aches. Given these findings, some researchers favor giving alefacept for 16 weeks to increase effectiveness; however, more long-term data is needed to determine if this is the optimal dosage. Another study indicates that repeated courses of alefacept are proving safe and effective. With each additional course, the proportion of patients responding rose, and multiple courses of alefacept did not increase the risk of severe side effects, such as serious infection or malignancies.
   

• Two cases of palmoplantar psoriasis effectively treated with alefacept. Two patients were living with the chronic discomfort and physical disability caused by severe palmoplantar psoriasis because nothing they tried worked. Topical corticosteroids, systemic corticosteroids, phototherapy, methotrexate, cyclosporine, and other therapies all failed to alleviate the signs and symptoms. By the time alefacept was started, the condition was significantly affecting their ability to perform daily tasks, such as handling paper and walking, and interfering with their work. Each patient received 12 doses of alefacept and experienced significant improvement. One patient said the quality of her life had greatly improved, and she is “very happy with the results.” After eight doses, the second patient was able to sew again. After 10 doses, she was able to walk without pain.
  
  Note: The results were observed in only two patients, and these patients were not part of a clinical trial.
   

• Safe to begin alefacept while gradually tapering off other therapies. Preliminary data from ongoing clinical studies indicates that it is safe and effective to begin alefacept while gradually tapering off another treatment for psoriasis.  Studies have looked at the safety and efficacy of alefacept when patients are using mid- to high-potency topicals, methotrexate, cyclosporine, phototherapy, or systemic retinoids. The data suggests that it is safe to begin alefacept while tapering off any of these therapies.
   

• Efalizumab proving safe for continuous long-term therapy. Studies continue to look at the safety, effectiveness, and tolerability of the biologic efalizumab, which is meant to provide continuous long-term therapy for patients with moderate to severe plaque psoriasis. Researchers recently investigated the safety and patients’ ability to tolerate the medication when treated for up to 60 continuous weeks. Results showed that efalizumab was well tolerated in patients with moderate to severe plaque psoriasis. New side effects were not reported, and the most common side effects were minor flu-like symptoms, such as headache, chills, fever, and nausea. There was no evidence of the medicine being toxic to the organs. An ongoing clinical trial reports that patients who had received 30 months of continuous therapy had no overall increase in side effects and new side effects did not occur. Additionally, there was no evidence of damage to organs caused by continuous use. Results from these studies suggest that efalizumab can be used as continuous therapy for long-term control in patients with severe or chronic plaque psoriasis.
   

• Etanercept can be safely withdrawn and remains effective with intermittent use. Etanercept has been used for years to treat rheumatoid arthritis and has an excellent safety profile when taken by these patients for extended periods of time. Cumulative toxic effects have not been observed with long-term use. Researchers want to know if the same holds true for patients with severe plaque psoriasis and psoriatic arthritis - two conditions for which etanercept was recently approved. Like efalizumab, etanercept is prescribed for continuous long-term treatment. Recent clinical trials have looked at what happens when etanercept is used to treat plaque psoriasis and the medication is discontinued or used intermittently. Results show that when etanercept is discontinued the psoriasis gradually relapses in approximately three months. Withdrawal is well tolerated and does not cause a severe flare. Beginning treatment again does not diminish the effectiveness nor increase side effects. Researchers conclude that while etanercept has been used continuously to treat rheumatic conditions, data suggests that rotating or intermittently using etanercept to treat plaque psoriasis can be safe and effective.
   

• Etanercept responses similar among patients with varying treatment histories. Researchers recently studied how patients who have received other psoriasis therapies, such as methotrexate, cyclosporine, acitretin, psoralen with ultraviolet-A radiation (PUVA), and ultraviolet B radiation (UVB), respond to etanercept. Before being treated with etanercept all patients underwent a washout of systemic medications, stopped phototherapy treatments for at least 4 weeks, and agreed not to use topical medications for at least 2 weeks. Researchers classified these patients’ overall response to etanercept as “excellent.” Patients who had more severe psoriasis at the time the study began responded equally as well as patients with less severe psoriasis. At week 24, improvements ranged from 58% to 65%, and there was no significant difference among patients who had been treated with other psoriasis therapies.