December 19, 2014
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Systemic treatments for psoriasis

Systemic treatments are medications that work from within the body and are taken either by mouth or by injection. These medications are used to treat moderate-to-severe psoriasis. Systemic treatments for psoriasis include:

Systemic medications may be combined with other psoriasis treatments (such as topical treatments or light therapy).

Talk to your doctor about the most appropriate psoriasis treatment for you. With effective treatment and management, psoriasis lesions can be cleared.

Biologic treatments for psoriasis

The group of medications known as biologics (or biological response modifiers) work by decreasing the activity of the immune cells that become overactive in psoriasis. This helps control skin cell overgrowth and inflammation. Biologics are used to treat moderate-to-severe psoriasis.

The biologics available in Canada to treat psoriasis include:

  • ustekinumab (Stelara®)
  • infliximab (Remicade®)
  • etanercept (Enbrel®)
  • adalimumab (Humira®)

Talk to your doctor about the most appropriate psoriasis treatment for you. With effective treatment and management, psoriasis lesions can be cleared.

Ustekinumab

How it works
Ustekinumab (Stelara®) works by blocking the action of two proteins in the body called interleukin 12 and interleukin 23. These specific proteins are thought to be involved in causing the immune system to become overactive, which causes psoriasis.

How it is used
Ustekinumab is given by subcutaneous (under the skin) injection, again 4 weeks later, then every 12 weeks thereafter.

Side effects of ustekinumab
Ustekinumab side effects include headaches and allergic reaction (signs may include a skin rash; swollen face, lips, mouth, or throat; wheezing; dizziness; trouble swallowing or breathing).

The immune-system-modifying effects of this medication decrease the body's ability to fight infection. Because of this, when taking this medication, there is an associated risk of infection, including upper respiratory tract infection (e.g., sore throat, sinus infection) or infections such as tuberculosis, systemic fungal, viral, and bacterial infections, and increased risk of cancer.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Infliximab

How it works
In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Infliximab (Remicade®) works by blocking the action of TNF alpha.

How it is used
Infliximab is given as an intravenous infusion (injected into the vein over 2 hours), again 2 and 6 weeks later, then every 8 weeks thereafter. Infusions are given under the supervision of health care professionals such as nurses and doctors at infusion centres or clinics.

Side effects of infliximab
Infliximab side effects include shortness of breath, rash, headache, abdominal pain, back pain, coughing, diarrhea, dizziness, fatigue, itchiness, upset stomach, nervous system disorders (e.g., multiple sclerosis, seizures), allergic reactions, and reactions to the intravenous infusion (e.g., hives, difficulty breathing, chest pain).

The immune-system-modifying effects of this medication decrease the body's ability to fight infection. Because of this, when taking this medication, there is an associated risk of serious systemic fungal, viral, and bacterial infections (e.g., tuberculosis, sepsis); upper respiratory tract infections (e.g., sore throat, bronchitis, sinus infection); urinary tract infections; flu-like symptoms; and increased risk of cancer.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Etanercept

How it works
In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Etanercept (Enbrel®) works by blocking TNF alpha in the body to help reduce psoriasis lesions.

How it is used
Etanercept is given twice a week by subcutaneous (under the skin) injection for the first 3 months of treatment. After the first 3 months of treatment, it may be given once or twice weekly.

Side effects of etanercept
Etanercept side effects include injection site reactions (e.g., swelling, itching, or rash), headache, and upper respiratory tract infections (e.g., sore throat, sinus infection).

The immune-system-modifying effects of this medication decrease the body's ability to fight infection. Because of this, when taking this medication, there is an associated risk of serious systemic fungal, viral, and bacterial infections (e.g., tuberculosis, sepsis); nervous system disorders (e.g., multiple sclerosis, seizures); and increased risk of cancer.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Adalimumab

How it works
In psoriasis, tumour necrosis factor alpha (TNF alpha) is one of the substances in the immune system that is overproduced, causing too much inflammation in the body. Adalimumab (Humira®) works by blocking TNF alpha in the body to help reduce psoriasis lesions.

How it is used
Adalimumab is given by subcutaneous (under the skin) injection, again one week later, then every 2 weeks.

Side effects of adalimumab
Side effects of adalimumab include injection site reactions (e.g., swelling, itch, or rash), headache, upper respiratory tract infections (e.g., sore throat, sinus infection), rash, and nausea.

The immune-system-modifying effects of this medication decrease the body's ability to fight infection. Because of this, when taking this medication, there is an associated risk of serious systemic fungal, viral, and bacterial infections (e.g., tuberculosis, sepsis); nervous system disorders (e.g., multiple sclerosis, seizures); and increased risk of cancer.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

With all treatments, it is very important to follow the directions provided by your doctor or pharmacist.

The best treatment for you may depend on the severity of your psoriasis. Be sure to consult the DLQI (Dermatology Life Quality Index) to determine the impact of your condition and work with your doctor to choose the most satisfactory treatment option.

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Cytotoxic agents for psoriasis

How it works
Methotrexate belongs to a class of medications called cytotoxic agents or anti-metabolites. It works by blocking the function of a particular enzyme required for proper growth of some cells. In psoriasis, this helps to slow down the rapid overgrowth of skin cells.

How it is used
Methotrexate can taken by mouth, usually once a week. It can also be given as an injection into a muscle or vein by a health care provider once a week.

Side effects of methotrexate
Common side effects of methotrexate include nausea, vomiting, upset stomach, stomach pain, loss of appetite, dizziness, fever and chills, diarrhea, sores on mouth or lips, tiredness, decreased white blood cell count (which could lead to a decreased ability to fight infection), sore throat, and swelling of glands.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

With all treatments, it is very important to follow the directions provided by your doctor or pharmacist.

The best treatment for you may depend on the severity of your psoriasis. Be sure to consult the DLQI (Dermatology Life Quality Index) to determine the impact of your condition and work with your doctor to choose the most satisfactory treatment option.

Take the next step…

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Immunosuppressants for psoriasis

How it works
Cyclosporine (Neoral® and generics) belongs to the group of medications known as immunosuppressants. It controls the skin cell overgrowth seen in psoriasis by decreasing the activity of the immune system.

How it is used
Cyclosporine is taken by mouth twice a day.

Side effects of cyclosporine
Common side effects of cyclosporine include high blood pressure; increased levels of lipids (e.g., cholesterol); kidney or liver problems; slight trembling of the hands; headache; night sweats; muscle pain; joint pain; upset stomach; tingling sensations in the fingers, toes, or mouth; loss of appetite; nausea; vomiting; diarrhea; acne or oily skin; anxiety; swollen or tender gums; and decreased ability to fight infection.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Take the next step…

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Retinoids for psoriasis

How it works
Acitretin (Soriatane®) belongs to the group of medications known as retinoids, which are synthetic forms of vitamin A. It is believed to work by reducing the speed of skin cell growth.

How it is used
Acitretin is taken by mouth once a day with food.

Side effects of acitretin
Common side effects of acitretin include muscle and joint pain, hair loss, dry lips, dry mouth, itchy skin, sticky skin, peeling skin (fingertips, palms, soles), thinning of the skin, runny nose, dry nose, dry eyes, and nail disorder. Acitretin can cause birth defects, so pregnant women or women planning to become pregnant should not take this medication.

Many side effects are manageable. Talk to your doctor or pharmacist if you are experiencing any side effects.

This is not a complete list of all side effects, warnings, and precautions. For detailed and current information for each medication, see the Consumer Information section of the approved Product Monograph, which can be found on the Health Canada website.

Take the next step…


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