Sep 26, 2014

Negative Results in Treatment of Psoriasis

Psoriasis is one of the most common dermatological diseases. It is characterized by red, thickened, well demarcated and symmetrical plaques in the skin with a silvery scale. The lesions vary in size depending on the degree of inflammation.

For localized skin lesions, the treatment begins with combination of topical corticosteroids and coal tar, or calcipotriene. The primary goal of therapy is to maintain control of the lesions, since the cure is seldom achieved. If the topical therapy fails or if psoriasis is generalized, the patient may benefit from systemic therapy. [1]

Although abnormal epidermal cell proliferation and abnormal activation of immune mechanisms are known to be a major contributory factor in psoriasis, the primary etiology of psoriasis remains unknown. [2] Topical therapy includes topical corticosteroids, calcipotriene (a vitamin D3 analog), coal tar, anthralin, tazarotene, PUVA (Psoralen plus ultraviolet A) and UVB (Ultraviolet B) light. Other recommended systemic therapies include retinoids, methotrexate, and cyclosporine. [1]

Recent studies revealing the pathophysiology of psoriasis has enabled the discovery of new drugs for psoriasis. However, some drugs which were believed to be effective later were proven to be ineffective, or withdrawn from the market due to troublesome side effects. The purpose of this article is to provide a review about the ineffective treatment options of psoriasis.

Efalizumab, a full-length IgG1 kappa isotype antibody composed of two identical kappa light chains and two gamma heavy chains (structure consistent with the structure of human IgG1), one of the drugs voluntarily withdrawn from the market by the manufacturing company in 2009 because the risk-benefit ratio for treating psoriasis was no longer considered to be favourable. [3,4]

It interferes with T-cell function, which plays a main role in the pathogenesis of psoriasis. Progressive Multifocal Leukoencephalopathy (PML) is one of the recognized complications of the long term treatment with Efalizumab. Rare but deadly infections like bacterial sepsis, viral meningitis, invasive fungal disease and other opportunistic infections are also known as severe complications that outweigh the benefits. [4]

There is no evidence relating to the efficacy of Efalizumab upon retreatment. Since few studies have followed up patients treated with Efalizumab for long periods of time, the safety in long term use of it should be studied further. [5]

The association between streptococcal infections and guttate psoriasis, or plaque psoriasis, has been known for a long time and is well-documented. Streptococcal throat infections are related to the incidence of psoriasis onset. However, a Cochrane review has not shown evidence that tonsillectomy or antistreptococcal treatments are beneficial in treatment or prevention of guttate psoriasis, [6] although some studies had shown them to be effective in prevention and treatment of psoriasis. [7]

[1]. Asha G. Pardasani, Steven R. Feldman, Adele R. Clark. Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians. Am Fam Physician. 2000 Feb 1; 61(3):725-733.

[2]. Feldman SR. Psoriasis treatment. Curr Prob Dermatol. 1998;1011–40.

[3]. Carson KR, Focosi D, Major EO, Petrini M, Richey EA, West DP, et al. Monoclonal antibody associated progressive multifocal leukoencephalopathy in patients treated with rituximab, natalizumab, and efalizumab: a review from the Research on Adverse Drug Events and Reports (RADAR) project. Lancet Oncol. 2009; 10:816–824.

[4]. NICE guidelines. Etanercept and efalizumab for the treatment of adults with psoriasis. July 2006.

[5]. Woolacott N1, Hawkins N, Mason A, Kainth A, Khadjesari Z, Vergel YB, Misso K, Light K, Chalmers R, Sculpher M, Riemsma R. Etanercept and efalizumab for the treatment of psoriasis: a systematic review. Health Technol Assess. 2006 Nov; 10(46):1-233, i-iv.

[6]. Owen CM, Chalmers RJ, O’Sullivan T, Griffiths CE. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database of Systematic Reviews 2000, Issue 2.

[7]. Ozawa A, Ohkido M, Haruki Y, et al. Treatments of generalized pustular psoriasis: a multicenter study in Japan. J Dermatol. 1999;26:141–9.

Written by Dra. Belén Suárez Jiménez fot The All Results Journals

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