Psoriasis - Other Medications

To minimize complications of cyclosporine, the dosage is reduced after improvement occurs. Maintenance therapy is usually limited to a year, although some experts believe that a microemulsion form of Neoral (Neoral-Neo) may safe for up to two years. Patients should be monitored regularly for hypertension and signs of kidney or liver abnormalities and evaluated for skin cancers.

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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 agent. 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--and also grapefruit and grapefruit juice.

Second- and Third-Line Systemic Agents

Second- or third-line agents are used alone or sometimes in combination with first-line systemic drugs if those medications fail. Most are investigative and are generally less safe than first-line agents.

Sulfasalazine. Sulfasalazine (Azulfidine) sometimes used for psoriasis. In one major analysis, sulfasalazine and methotrexate were the only agents proven to help patients with psoriatic arthritis. Many people, however, stop taking the drug because of common side effects that include headaches, gastrointestinal complaints, and rash. Benefits, if any, should be apparent in four to six weeks.

Macrolides. Macrolides are agents that fight bacteria and also have immunosuppressant properties. (Their actions are similar to those of cyclosporine.) Some macrolides being studied for psoriasis include tacrolimus (Prograf), pimecrolium, and sirolimus. In one study, for example, tacrolimus showed an 83% reduction in symptoms in patients with psoriasis who used the drug. Studies have been limited, however. Side effects of these agents are similar to those of cyclosporine. Pimecrolimus may specifically target the skin and so have fewer side effects. (Some macrolides are also being studied as topical treatments.)

Biologic Response Modifiers

Biologic response modifiers, sometimes called "biologics," belong to a new class of drugs that are considered the most exciting development in psoriasis treatment.Four such drugs have been approved since 2003. 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 the way that general immunosuppressants do.