THURSDAY, April 19 (HealthDay News) -- Newer, more expensive
medications don't work much better for the chronic inflammatory
skin disease known as psoriasis than the standard treatment, a new
The researchers found that biologics, which can cost upwards of
$10,000 a year, were slightly more effective than a standard drug
treatment for psoriasis, methotrexate, but that their impact
lessened over time.
The findings provide only limited hope for psoriasis sufferers,
who sometimes stop traditional treatments because of nausea and
other bad reactions.
"When one looks at the outcome as being clear, or almost clear [skin], the biologics appear to be more effective than methotrexate," said study author Dr. Joel Gelfand. But, when total body surface area affected by the disease is added in that difference diminishes, he said.
The study, published in the April issue of the
Archives of Dermatology, was conducted from February 2010 through June 2011 in clinics at the University of Pennsylvania and University of Utah, as well as six private practices around the country. It was designed to look at treatment "in real-world conditions," as opposed to clinical trials, which have showed better results in the past, the study said.
Psoriasis, an autoimmune system disease, causes itchy, scaly,
red patches of skin, mostly on the elbows, knees and torso.
Moderate to severe rashes afflict about 25 million people
worldwide, including 1.4 million people in the United States.
The condition usually emerges in early adulthood, and is
associated with elevated risks of cardiovascular disease and early
death, according to research cited in the study.
Genetics play an "important role" in who gets psoriasis, said
Gelfand, who is also an assistant professor of dermatology and
epidemiology at the University of Pennsylvania, noting that
environmental factors such as smoking and excess weight have also
been linked to the condition.
Some patients find methotrexate and other older medications
difficult to tolerate and stop using them because of side effects
such as nausea, hair thinning or liver problems, Gelfand
In the research, three biologics and phototherapy were compared
with methotrexate, an immunosuppressant also used in cancer
The study included 713 patients, almost equally divided among
men and women, who were rated once for severity of the condition
during a regularly scheduled appointment for treatment of
psoriasis. Those who had a clear or almost clear skin assessment
ranged from 24 percent for methotrexate users to between 34 and 48
percent for the three biologics studied. But, patients on
methotrexate had about 3 percent of body surface affected, compared
to 2 percent for the biologics, a small difference, said
Biologics can cost $10,000 to $20,000 a year, compared to a
couple of thousand dollars for older drugs or phototherapy, said
Phototherapy was found to be about as effective as methotrexate,
but is inconvenient because patients must see a doctor three times
a week for three months to obtain the recommended dosage, and
patients often don't comply with the regimen, Gelfand noted.
On self-assessments, patients found no significant differences
among the treatments.
In contrast to the study, another expert on psoriasis said the
newer drugs represent a real breakthrough.
Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New
York City, said biologics have worked better for many of her
patients and have had fewer side effects. The drugs "give patients
hope where there was no hope before," she said.
"In an otherwise healthy patient, if the patient has no infections, no TB [tuberculosis] and is not immuno-compromised, the risk with the biologics is low," she said.
Phototherapy poses a risk of skin cancer for fair-skinned people
and "you end up with sun-damaged skin and psoriasis," said Day.
"Also, psoriasis is a systemic disease, so systemic treatments
affect more than just the skin, hopefully keeping people
She noted that it was important to monitor patients for
cardiovascular problems and other conditions, because "it's a
To learn more about psoriasis, visit the
U.S. National Library of Medicine.
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