1. Cyclosporine Affirmed.
Despite a paucity of evidence-based studies, cyclosporine remains a safe and
effective drug for the treatment of psoriasis, according to the 2008 National Psoriasis Foundation
Consensus Conference (J Am Acad Dermatol 2009 Nov 23, e-pub). Specifically, researchers noted that
cyclosporine is “particularly useful in managing psoriatic crises, treating psoriasis unresponsive to
other modalities, bridging to other therapies, and treating psoriasis within a rotational scheme of other
medications.” The panel emphasized appropriate monitoring to minimize risks.
2. Methotrexate LFTs Addresed.
During his presentation at the AAD Annual Meeting in Miami last
month, Mark Lebwohl, MD referenced a report from the National Psoriasis Foundation suggesting
new guidelines for use of methotrexate. The report notes that PPD tests should be performed during
baseline monitoring, in addition to other tests. He also observed that monitoring for hepatoxicity is
as important for lower-risk patients. While baseline liver biopsies are not essential, he notes that it
is important to monitor liver function tests monthly for the first six months of treatment and then
one to two months thereafter.
3. Interactions Identified.
Methotrexate and cyclosporine may adversely interact with medications
commonly used in patients with psoriasis, a new report reminds (Dermatology. 220: 128-137). The
study evaluated rates of reported drug-related toxicity among patients with psoriasis who were
exposed or not exposed to potential drug interactions. Results showed that exposed patients had significantly
greater risks of developing renal, gastrointestinal, and pulmonary events, and significantly
greater health care resource utilization. Researchers concluded that methotrexate or cyclosporine
polypharmacy is prevalent among psoriasis patients and associated with significant risks.
4. Low-dose Acitretin Taking Hold.
Lower dose acitretin (25mg) has been found effective for psoriasis
and is associated with fewer adverse events, such as dry skin, alopecia, and rhinitis than high
dose (50mg) acitretin (Arch Dermatol. 142(8): 1000-4). Dr. Lebwohl also noted in his presentation
that a new meta-analysis shows low-dose acitretin may be becoming standard: more than 81 percent
of written prescriptions for acitretin were for 25mg or less.
5. Cost-efficiency Highlighted.
In the wake of rising biologic costs, traditional systemic therapies may
be more cost-efficient (Arch Dermatol. 146(1): 46-54). Researchers analyzed annual trends in the cost of
both generic and brand-name psoriasis drugs from 2000 through 2008. Current total annual costs for
systemic psoriasis therapies ranged from $1,197 (methotrexate) to $27,577 (alefacept, two 12-week
courses). The average wholesale price of brand-name psoriasis therapies from 2000 through 2008
increased 66 percent on average. Researchers concluded that despite higher monitoring costs associated
with traditional systemic therapies, annual costs of biologics exceed those of other therapies. Systemic
psoriasis therapy costs are increasing at a much higher rate compared with general inflation.
