April 18, 2014
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Psoriasis

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Systemic treatments for psoriasis

Systemic treatments are medications that work from within the body and are either taken 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®)
  • alefacept (Amevive®)
  • adalimumab (Humira®)

Talk to your doctor about the most appropriate psoriasis treatment for you. With effective treatment and management, psoriasis lesions can be cleared.1n

Ustekinumab

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

How it is used
Ustekinumab is given by subcutaneous (under the skin) injection at week 4 following the first dose, then every 12 weeks thereafter.

Side effects of ustekinumab
Side effects of ustekinumab include serious allergic reaction (signs may include a skin rash; swollen face, lips, mouth, or throat; wheezing; dizziness; trouble swallowing or breathing); increased risk of infection (because of the body's decreased ability to fight infection) including upper respiratory tract infection (e.g., sore throat, sinus infection); or serious infections such as tuberculosis, serious systemic fungal, viral, and bacterial infections; and increased risk of cancer.

Many side effects are manageable. Talk to your pharmacist or doctor 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) at 2 and 6 weeks following the first dose, then every 8 weeks thereafter. Infusions are given under the supervision of health care professionals such as nurses and doctors.

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); increased 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; allergic reactions; reactions to the intravenous infusion (e.g., hives, difficulty breathing, chest pain); and increased risk of cancer.

Many side effects are manageable. Talk to your pharmacist or doctor 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; upper respiratory tract infections (e.g., sore throat, sinus infection); increased 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 pharmacist or doctor 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.

Alefacept

How it works
In psoriasis, certain cells in the immune system called T cells are triggered and become overactive. Alefacept (Amevive®) works by helping prevent T cells from becoming overactive and by reducing the number of overactive T cells in the body.

How it is used
Alefacept is given once a week by intramuscular (into a muscle) injection or by intravenous injection. The usual treatment period is 12 weeks.

Side effects of alefacept
Side effects of alefacept include injection site reactions (e.g., pain, swelling, inflammation, bleeding), chills, flu-like symptoms, accidental injury, upper respiratory tract infections (e.g., sore throat, sinus infection), viral infection, headache, runny nose, feeling tired, diarrhea, nausea, dizziness, pain, increased risk of infections (e.g., tuberculosis, sepsis), and increased risk of cancer.

Many side effects are manageable. Talk to your pharmacist or doctor 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 every 2 weeks starting 1 week after the first dose.

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; nausea; increased 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 pharmacist or doctor 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 use the Psoriasis Severity Calculator to learn more about your condition.

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Cytotoxic agents for psoriasis

How it works
Methotrexate (methotrexate and generics) belongs to a class of medications called cytotoxic agents or anti-metabolites. It works by blocking the function of a particular enzyme. Blocking this enzyme interferes with the 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 pharmacist or doctor 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 use the Psoriasis Severity Calculator to learn more about your condition.

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Immunosuppressants for psoriasis

How it works
Cyclosporine (Neoral® and generics) belongs to the group of medications known as immunosuppressants. It works by controlling 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 pharmacist or doctor 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.

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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 pharmacist or doctor 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.

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