Systemic drugs are medications that are given either orally (pills) or as injections just below the skin (subcutaneous) or into the muscle (intramuscular), Since these medications enter the body's circulatory system directly, they are called systemic agents, and are usually reserved for patients with moderate to severe psoriasis, or for those with psoriatic arthritis. In addition, these medications are also used in combination with other therapies, including topicals and phototherapies, especially when a patient does not respond to a single type of treatment.
Currently, the most commonly used systemic agents for the treatment of psoriasis are methotrexate (Rheumatrex), cyclosporine (Sandimmune), and retinoids. These medications can provide significant benefit in clearing psoriasis, but they can have side effects. These side effects might occur either at the outset or shortly after starting the medication (acute side effects) or after prolonged use (long-term, chronic side effects). While on these medications, it is important to be closely monitored by your doctor. When taking any systemic agent, it is vital that the drug is taken as directed by your doctor.
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Methotrexate (MTX)
Methotrexate is a medication initially developed and approved to treat different types of cancer (chemotherapy), Methotrexate is also used to treat moderate to severe psoriasis and disabling psoriatic arthritis.
How Does Methotrexate Work?
Methotrexate is effective in erythrodermic, pustular, and severe plaque-type psoriasis, as well as psoriatic arthritis. Methotrexate is effective because it works in two major ways:
- It reduces the rapid turnover of the skin cells, an important process in producing the thick, scaling lesions of psoriasis.
- It has an anti-inflammatory effect on white blood cells (activated T-cells), which are important in the development of psoriasis lesions (and suppression of the immune system).
Patients Who May Benefit from Methotrexate
- those with erythrodermic psoriasis (entire body is covered by red scaling lesions)
- those with pustular psoriasis (generalized or localized such as palmoplantar pustulosis)
- those with plaque-type psoriasis (involving the hands, feet, face) or extensive body areas
- those with psoriatic arthritis
- those who fail to respond to topical therapies, phototherapy, or other systemics (retinoids, cyclosporine) or biologics
Is Methotrexate Right for You?
Before starting you on treatment with methotrexate, your doctor might ask several questions, examine you, and discuss with you the benefits and risks. As with any treatment, the risks should not outweigh the benefits.
Your doctor will ask you about other diseases or disorders that could prohibit you from taking methotrexate (e.g., liver and/or kidney disease). Because methotrexate is eliminated by the kidneys, if they do not function properly, the drug cannot be properly removed from the body. In addition, with high doses of methotrexate, there is a possibility of kidney damage, in which case the dose would be lowered or another method of treatment considered.
One of the most significant concerns with long-term use of methotrexate is cirrhosis (scarring) of the liver. In general, it appears that patients at highest risk for cirrhosis are:
- obese
- drinking alcohol while taking methotrexate
- diabetic (the pancreas does not produce enough insulin)
- long-term users of methotrexate
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Before starting treatment, certain blood tests will also be performed to test the liver, kidneys, and blood cell counts. These tests are usually repeated weekly for one month at the beginning of treatment and if and when the dose of methotrexate is increased. After this, testing will be done regularly. Regular blood work is important because it may help in the early detection of any signs of injury or irritation to your kidneys, liver, or blood cells, and gives your doctor the opportunity to alter your dosage or discontinue the treatment, if necessary. To find out more, you can check out Shot For Psoriasis.