Let’s take a second look at traditional therapies for psoriasis

CHICAGO―Biologics certainly have shown to be an effective treatment in plaque psoriasis, but physicians should not discount more traditional therapies for treating psoriasis.

According to Laura Ferris, M.D., Ph.D., a dermatologist from the University of Pittsburgh, traditional systemic and small molecule therapies can still be effective treatment options for many patients.

“Simply because a drug is older doesn’t mean it’s not effective,” she said. “They have their role to play in therapy, and we need to be comfortable using them.”

During her presentation at the 20th annual Residents Meeting of the National Psoriasis Foundation, Dr. Ferris discussed several drugs, including methotrexate and cyclosporine, and how they can still be good alternatives for a large number of patients.

“Having knowledge about these traditional therapies expands a resident’s tool box. Not every patient responds to every drug,” she said. “You need to know and come up with more and more options for harder to treat patients.”

Alongside discussing which traditional and small molecule therapies can be used in patient care, Dr. Ferris discussed new research that sheds light on how methotrexate actually works. Now, researchers have a better understanding of the role methotrexate plays in upregulating the function of regulatory T-cells.

There’s also additional research ongoing into how best to use subcutaneous methotrexate, she said, as well as new work on how the drug might impact male fertility. Dr. Ferris also discusses the impacts of acitretin and tofacitinib on modulating the immune system and psoriatic arthritis, respectively.

Residents should also have as much of an understanding as they can for natural therapies that their patients might pursue. This can be difficult, she said, because there isn’t much clinical data on natural therapies. However, recent research into curcumin indicates it inhibits the phosphorylase kinases that increase in psoriasis. According to the data, curcumin is both safe and effective, she said.

In addition, Dr. Ferris told residents, they must be aware that patients don’t only come in with skin disease. They potentially come in with a variety of co-morbidities that must be addressed. Consequently, residents need to have a good working knowledge of traditional therapies to know which treatment options will work best without causing complications.

“These are drugs that are still good options for patients,” she said. “For some patients who might not want to take a shot or be on a biologic, these can be options for those patients.”

REFERENCE

Ferris, L. “Traditional Systemic & Small Molecule Therapies,” 20th Resident Meeting National Psoriasis Foundation, Chicago, Illinois. Oct. 20, 11-11:45am.