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Side Effects. Cyclosporine has significant side effects if used for a long time, notably kidney problems and non-melanoma skin cancers. It should be reserved for patients who do not respond to phototherapy or less potent systemic medications (for example, methotrexate or acitretin).
Common and temporary side effects include:
- Fatigue
- Gingivitis
- Gout
- Hair growth
- Headaches
- Joint pain
- Tremor
More serious complications may include:
- Kidney damage
- High blood pressure (Some doctors advise treating high blood pressure with calcium channel blockers, because other standard blood pressure drugs may worsen psoriasis. Calcium channel blockers also help prevent kidney problems.)
- High cholesterol and lipid levels
- High levels of calcium and low levels of magnesium
- Increased risk for infections
- Liver problems
- Lymphomas
- Skin cancers (Patients who take cyclosporine after PUVA therapy have a higher incidence of squamous cell skin cancer. The risks are greatest with long-term and previous use of PUVA, methotrexate, or other immunosuppressants.)
To reduce complications of cyclosporine, the dosage is decreased after improvement occurs. Maintenance therapy is usually limited to a year, although some experts believe that a microemulsion form of Neoral (Neoral-Neo) may be safe to use for up to 2 years. Patients should be monitored regularly for high blood pressure and signs of kidney or liver problems and skin cancers.
Patients Who Should not Use Cyclosporine. Because the drug suppresses the immune system, people with active infections or cancer should avoid it. Patients with uncontrolled high blood pressure and impaired kidney function should also not use this medication. Cyclosporine therapy for children with psoriasis has not been well studied.
Drug and Food Interactions. Cyclosporine interacts with numerous drugs -- both prescription and over-the-counter preparations -- as well as grapefruit and grapefruit juice.
Newer forms of cyclosporine that have fewer side effects are being investigated.
Biological Response Modifiers
Biological response modifiers, sometimes called "biologics," belong to a new class of drugs that are considered the most exciting development in psoriasis treatment. Biologics are genetically engineered drugs that interfere with specific components of the autoimmune response. Because of their precise targets, these drugs do not damage the entire immune system like general immunosuppressants.
Biologics are traditionally second- or third-line treatments, and may be used alone or in combination with first-line systemic drugs. Depending on the severity of psoriasis, some of these drugs may be used earlier in the course of treatment. Studies of these medications have primarily been done on patients who are over 18 years old.
There are different types of biologics used to treat psoriasis:
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Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School. Also reviewed by David Zieve, MD, MHA,
Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
