Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012, 156(1):29-40 | DOI: 10.5507/bp.2012.007

Experience with the systemic treatment of severe forms of psoriasis

Martin Tichya, Jana Zapletalovab
a Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
b Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc

Introduction: Severe forms of psoriasis are indicated for systemic treatment with conventional and biological preparations. The former includes methotrexate, cyclosporin, acitretin and narrow-band ultraviolet B phototherapy but toxicity may limit the dose and duration of treatment. Currently used less toxic biological preparations include inhibitors of TNF-alpha (etanercept, adalimumab, infliximab) and the monoclonal antibody against IL 12/23 ustekinumab. We present our own more than five-year experience with the systemic treatment of severe forms of psoriasis using these preparations.

Methods: A total of 66 patients treated with systemic therapy (except for phototherapy) were divided into groups based on treatment. Therapeutic doses were administered according to the recommendations of the manufacturer and dermatological societies. Standard PASI and BSA indexes were used to evaluate clinical condition at weeks 0, 12 and 24.

Results: Differences in PASI score reduction and BSA index between patient groups treated with different preparations were statistically significant at monitored intervals. At week 12, PASI score was reduced by 75% or more in a significantly greater number of patients treated with infliximab + methotrexate than those treated with acitretin. At week 24, identical comparison showed a significantly greater number of patients treated with etanercept or adalimumab than those receiving methotrexate. For BSA index reduction by 50% or more, no statistically significant differences were found between patient groups during the follow-up period.

Conclusion: Systemic therapy provides a significant benefit to patients with severe psoriasis. Biological preparations are more effective than conventional medications which are often limited by severe side-effects and generally less tolerated than biological treatments.

Keywords: psoriasis, systemic therapy, conventional therapy, biological therapy, adalimumab, etanercept, infliximab, ustekinumab

Received: August 15, 2011; Accepted: January 4, 2012; Prepublished online: January 30, 2012; Published: March 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Tichy, M., & Zapletalova, J. (2012). Experience with the systemic treatment of severe forms of psoriasis. Biomedical papers, 156(1), 29-40. doi: 10.5507/bp.2012.007
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Tichy M, Ditrichova D. Biologicals in the treatment of severe forms of psoriasis. Dermatol praxi 2007;1:19-21.
    2. Tichy M, Ditrichova D. Biological treatment in dermatology. Klin Farmakol Farm 2008;22(2):68-71.
    3. Bachmann F, Nast A, Sterry W, Philipp S. Safety and efficacy of the tumor necrosis factor antagonists. Semin Cutan Med Surg 2010;29(1):35-47. Review. Go to original source... Go to PubMed...
    4. Kurzeja M, Rudnicka L, Olszewska M. New interleukin 23 pathway inhibitors in dermatology: ustekinumab, briakinumab and secukinumab. Am J Clin Dermatol 2011;12(2):113-25. Go to original source... Go to PubMed...
    5. van de Kerkhof PCM, Segaert S, Lahfa M, Luger TA, Karolyi Z, Kaszuba Z, Leigheb G, Camacho FM, Forsea D, Zang C, Boussuge MP, Paolozzi L, Wajdula J. One weekly administration of etanercept 50mg is efficacious and well tolerated in patients with moderate- to-severe plaque psoriasis: a randomized controlled trial with open-label extension. Br J Dermatol 2008;159:1177-85. Go to original source... Go to PubMed...
    6. Leonardi C, Papp K, Strober B, Reich K, Asahina A, Gu Y, Beason J, Rozzo S, Tyring S. The long-term safety of adalimumab treatment in moderate to severe psoriasis: a comprehensive analysis of all adalimumab exposure in all clinical trials. Am J Clin Dermatol 2011;12(5):321-37. Go to original source... Go to PubMed...
    7. Hoffmann JH, Hartmann M, Enk AH, Hadaschik EN. Autoantibodies in psoriasis as predictors for loss of response and anti infliximab antibody induction. Br J Dermatol (Epub ahead of print). Go to PubMed...
    8. Lebwohl M, Leonardi C, Griffiths CE, Prinz JC, Szapary PO, Yeilding N, Guzzo C, Li S, Hsu MC, Strober B. Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (Part I of II): Results from analyse of general safety from pooled Phase 2 and 3 clinical trials. J Am Acad Dermatol 2011 (Epud ahead of print). Go to original source...
    9. Benakova N, Stork J. Treatment of Psoriasis with Biologicals. Consensual Guidelines of The Czech Dermatovenereological Society of the CMA JEP 2006. Ces Slov Derm 2006;81(4):S1-11.
    10. Smith CH, Anstey AV, Barker JN, Burden AD, Chalmers RJG, Chandler DA, Finlay AY, Griffiths CEM, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD. British Association of Dermatologists´ guidelines for biologic interventions for psoriasis 2009. Br J Dermatol 2009;161(5):987-1019. Go to original source... Go to PubMed...
    11. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret R, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Hönigsmann H, Hussain M, Jobling R, Karvonen SR, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne JP, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H, Thio HB, Van de Kerkhof P, Rzany B. European S3- Guidelines on systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23(suppl. 2):1-70. Go to original source... Go to PubMed...
    12. Papp K, Gulliver W, Lynde C, Poulin Y, Ashkenas J, Canadian Psoriasis Guidelines Committee. Canadian giudelines for the management of plaque psoriasis: overview. J Cutan Med Surg 2011;15(4):192-200. Go to original source... Go to PubMed...
    13. Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CE, Nast A, Franke J, Antoniou C, Arenberger P, Balieva F, Bylaite M, Correia O, Daudén E, Gisondi P, Iversen L, Kemény L, Lahfa M, Nijsten T, Rantanen T, Reich K, Rosenbach T, Segaert S, Smith C, Talme T, Volc-Platzer B, Yawalkar N. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res 2011;303(1):1-10. Go to original source... Go to PubMed...
    14. American Academy of Dermatology Work Group, Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol 2011;65(1):137-74. Review. Go to original source... Go to PubMed...
    15. Ettler K. Indexy v klinickém hodnocení psoriázy a atopického ekzému. Čes-slov Derm 1995;70(1):45-7.
    16. Benakova N, Ettler K, Stork J, Vasku V. Psoriaza nejen pro praxi, Praha: Triton; 2007,164 s.
    17. Garduno J, Bhosle MJ, Balkrishnan R, Feldman SR. Measures used in specifying psoriasis lesion(s), global disease and quality of life: a systematic review. J Dermatol Treat 2007;18:223-42. Go to original source... Go to PubMed...
    18. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007;370:263-71. Go to original source... Go to PubMed...
    19. Christophers E. Comorbidities in psoriasis. J Eur Acad Dermatol Venereol 2006;20:52-5. Go to original source... Go to PubMed...
    20. Krueger JG, Bowcock A. Psoriasis pathophysiology: current concept of pathogenesis. Ann Rheum Dis 2005;64:30-6. Go to original source... Go to PubMed...
    21. Vasku V. Comorbidities in psoriasis a new perspective of an old disease. Dermatol praxi 2009;3(2):63-6.
    22. Revicki D, Willian MK, Saurat JH, Papp KA, Ortonne JP, Sexton C, Camez A. Impact of adalimumab treatment on health-related quality of life and other patient-reported outcomes: results from a 16-week randomized controlled trial in patients with moderate to severe plaque psoriasis. Br J Dermatol 2008;158:549-57. Go to original source... Go to PubMed...
    23. Reich K, Nestle FO, Papp K, Ortonne JP, Wu Y, Bala M, Evans R, Guzzo C, Li S, Dooley LT, Griffiths CE. Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial. Br J Dermatol 2006;154:1161-8. Go to original source... Go to PubMed...
    24. Tyring S, Gottlieb A, Papp K, Gordon K, Leonardi C, Wang A, Lalla D, Woolley M, Jahreis A, Zitnik R, Cella D, Krishnan R. Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet 2006;367:29-35. Go to original source... Go to PubMed...
    25. Krishnan R, Cella D, Leonardi C, Papp K, Gottlieb AB, Dunn M, Chiou CF, Patel V, Jahreis A. Effects of etanercept therapy on fatigue and symptoms of depression in subjects treated for moderate to severe plaque psoriasis for up to 96 weeks. Br J Dermatol 2007;157:1275-7. Go to original source... Go to PubMed...
    26. Menter A, Hamilton TK, Toth DP, Leung HM, Wetherill G, Hennessey B, Garovoy M, Kwon P, Pariser DM. Transitioning patients from efalizumab to alternative psoriasis therapies: findings from an open-label, multicenter, phase III study. Int J Dermatol 2007;46:637-48. Go to original source... Go to PubMed...
    27. Smith KC. Systemic therapy of psoriasis using methotrexate. Skin Therapy Lett 2000;6:1-2;5.
    28. Strober BE, Siu K, Menon K. Conventional systemic agents for psoriasis. A systematic review. J Rheumatol 2006;33:1442-6. Go to PubMed...
    29. Giannetti A. Commentary on the European S3- Guidelines on the systemic treatment of Psoriasis. J Eur Acad Dermatol Venereol 2010;24:p.368. Go to original source... Go to PubMed...
    30. Tichy M, Ditrichova D. Commentary to the Guidelines of The European Dermatology Forum on the Systemic Treatment of Psoriasis Vulgaris. Ces-slov Derm 2010;85(4):215-8.
    31. Menter A, Griffiths CE. Current and future management of psoriasis. Lancet 2007;370:272-84. Go to original source... Go to PubMed...
    32. Smith CH, Barker JNWN. Psoriasis and its management. BMJ 2006;333:380-4. Go to original source... Go to PubMed...
    33. Koo J. A randomized, double-blind study comparing the efficacy, safety and optimal dose of two formulations of cyclosporin, Neoral and Sandimmun, in patients with severe psoriasis. OLP302 Study Group. Br J Dermatol 1998;139:88-95. Go to original source... Go to PubMed...
    34. Murray HE, Anhalt AW, Lessard R, Schacter RK, Ross BJ, Stewart WD, Geiger JM. A 12-month treatment of severe psoriasis with acitretin: results of a Canadian open multicenter study. J Am Acad Dematol 1991;24:598-602. Go to original source... Go to PubMed...

    Return to the content