Are there any oral medications that help with widespread plaque psoriasis?

From the Guidelines

Methotrexate is the most recommended oral medication for widespread plaque psoriasis, with a dosage of 7.5-25 mg weekly, as it has been shown to be effective in treating moderate to severe psoriasis in adults 1. When considering treatment options for widespread plaque psoriasis, it's essential to weigh the benefits and risks of each medication.

• Methotrexate is a well-established treatment option, with a strength of recommendation of A for the treatment of moderate to severe psoriasis in adults 1.
• The recommended dosage of methotrexate typically ranges from 7.5 to 25 mg weekly, which can be given as a single dose or in 3 doses over 24 hours 1.
• Acitretin is another oral retinoid that can be used to treat psoriasis, with doses ranging from 10 to 50 mg daily 1.
• It's crucial to monitor liver function and adjust the dosage accordingly, as methotrexate can cause hepatotoxicity 1.
• Folic acid or folinic acid supplementation is recommended to reduce the incidence of gastrointestinal and hepatic adverse effects 1.
• The choice of medication ultimately depends on the severity of psoriasis, other medical conditions, and potential drug interactions, making it essential to consult a dermatologist to determine the most appropriate treatment option 1.

From the FDA Drug Label

The initial dose of cyclosporine [MODIFIED] should be 2.5 mg/kg/day. Cyclosporine [MODIFIED] should be taken twice daily, as a divided (1.25 mg/kg b.i.d.) oral dose. Patients should be kept at that dose for at least 4 weeks, barring adverse events. If significant clinical improvement has not occurred in patients by that time, the patient's dosage should be increased at 2 week intervals. Based on patient response, dose increases of approximately 0. 5 mg/kg/day should be made to a maximum of 4 mg/kg/day. Results of a dose-titration clinical trial with cyclosporine [MODIFIED] indicate that an improvement of psoriasis by 75% or more (based on PASI) was achieved in 51% of the patients after 8 weeks and in 79% of the patients after 16 weeks.

Yes, there is an oral medication that helps with widespread plaque psoriasis: cyclosporine (PO). The recommended initial dose is 2.5 mg/kg/day, and the dose can be increased up to 4 mg/kg/day based on patient response. Clinical trials have shown that 51% of patients achieved an improvement of 75% or more in psoriasis symptoms after 8 weeks of treatment, and 79% after 16 weeks 2.

From the Research

Oral Medications for Widespread Plaque Psoriasis

There are several oral medications that can help with widespread plaque psoriasis, including:

• Methotrexate (MTX) 3, 4, 5, 6
• Cyclosporine (CSA) 6, 7
• Acitretin (ACT) 6, 7
• Biological agents such as etanercept, adalimumab, infliximab, and ustekinumab 7

Methotrexate (MTX) Dosage

The dosage of MTX for plaque-type psoriasis varies, with some studies suggesting a start dose of 7.5 mg/week 3, 5 and others recommending a start dose of 15 mg/week 3, 5. One study found that a dose of 25 mg/week was more effective than 10 mg/week in achieving a 75% reduction in Psoriasis Area and Severity Index (PASI) scores 4.

Efficacy and Safety of Oral Medications

The efficacy and safety of oral medications for widespread plaque psoriasis have been studied in several trials. One study found that CSA was more effective than MTX and ACT in reducing modified PASI scores, but had a shorter duration of remission 6. Another study found that MTX and ACT had similar efficacy, but ACT provided a longer duration of remission 6. Biological agents have also been shown to be highly effective in the treatment of moderate-to-severe plaque psoriasis, with similar efficacy and safety profiles to anti-TNF agents 7.

Comparison of Oral Medications

A comparison of the efficacy and safety of oral medications for widespread plaque psoriasis found that:

• CSA had the fastest resolution of lesions and highest efficacy 6
• MTX and ACT had similar efficacy, but ACT provided a longer duration of remission 6
• Biological agents offered considerable advantages over previously available systemic therapies, including rapid onset and apparent lack of long-term toxicity 7