Current systemic therapies for psoriasis: where are we now?

Clinical Monograph for Drug Formulary Review: Systemic Agents for Psoriasis/Psoriatic Arthritis

“…15 These actions result in a reduction in DNA synthesis, inhibition of mitosis, and a decrease in the proliferation of rapidly dividing cells. Methotrexate is known to decrease T and B cell function and suppress the secretion of cytokines (IL-1, interferon-gamma, TNF).…”

“…15 Acitretin is the active metabolite of etretinate, previously known as Tegison. While etretinate takes years to be eliminated from the body, acitretin elimination takes several months.…”

“…15 The immunosuppressive effects of cyclosporine result from the inhibition of cytokine promoters, which eventually inhibits the transcription and processing of cytokines (IL-2, interferon-gamma) within the T cells and decreases T-cell growth and migration. Cyclosporine absorption is variable and incomplete, although a newer emulsion formulation of cyclosporine has better absorption, at 43%.…”

“…Hydroxyurea is an antineoplastic agent that inhibits DNA synthesis, which slows basal cell replication in the epidermis. 15 Hydroxyurea also inhibits vascular proliferation in the dermis; lowers the neutrophil count, which decreases pustule and papule formation; and reverses abnormal keratin formation. Sulfasalazine is an anti-inflammatory agent that is thought to work by inhibiting prostaglandin synthesis and interfering with the arachidonic pathway.…”

“…Azathioprine is an immunosuppressive agent that metabolizes to 6-mercaptopurine and inhibits DNA and RNA synthesis. 15 The mechanism of action of auranofin in treating psoriatic arthritis is unclear, but it is thought to work by reducing T-cell activity and inhibiting neutrophil migration. 18 Similarly, it is unclear how penicillamine exerts its effects in 22 The PASI is the most frequently encountered scale in the trials that follow and describes overall psoriasis severity and coverage, based on the amount of skin and degree of itching and scaliness involved in 4 defined body sections.…”