Treatments for Psoriasis

[pingu]

I am currently taking Methotrexate (MTX) and its shortcomings are well documented. Having to take bloods regularly, reducing alcohol intake etc etc. Fortunately I have not had any side effects apart from perhaps being slightly more susceptible to catching a cold and struggling to shake it off. Currently struggling to get rid of a cough after a chest infection.

The reason I believe MTX is the drug of choice for starting with psoriasis sufferers is that it is cheap and generally effective. I believe there are several drugs that could be used for the first round with differing degrees of effectiveness. I recal three but can't remember the names but MTX was said to work 80% of the time with the next closest only 50% effective.

I am aware of other drugs like humira, stelara, fumaderm etc but how do they all fit into the cost benefit model and which have the easiest administration and least side effects. Obviously there may be some very expensive drug with no side effects that you only take once a month but you would be unlikely to get that prescribed as a first choice.

Ideally I think a list of treatments, pros and cons, cost might be helpful. Obviously different treatments may cause different side effects in different people but from and ease of use I am thinking which has least impact on lifestyle, ie allows you to drink and not require blood tests etc.

[Fred]

Simple answer Stelara.
#1 One shot every 12 weeks: Easy
#2 Eat Drink what you like and as much as you like: Yum

Yes it's expensive but you don't pay for it and it gives people their lives back and results in less time off work, and as your confidence comes back you go out more and so help the economy by spending your money.

[Caroline]

You are partly wrong Pingu.
Next to methotrexate is Dimethylfumarate with an effectiveness of 70%. And it has the enormous advantage that it is way less toxic than MTX.
Fumaderm is though more expensive. But for me it is my health I am thinking about, which is an important factor in the choice of medication.

Surely it would be nice to create and build up a list with effective medications.

As far as I know there are no medicines that are 100% effective and without side effects.

[pingu]

Thanks Fred

Would it be realistic to go from MTX to stelara? What are the side effects? Would my derm be looking at other treatments before going to stelara.

[jiml]

You are partly wrong Pingu.
Next to methotrexate is Dimethylfumarate with an effectiveness of 70%. And it has the enormous advantage that it is way less toxic than MTX.
Fumaderm is though more expensive. But for me it is my health I am thinking about, which is an important factor in the choice of medication.

Surely it would be nice to create and build up a list with effective medications.

As far as I know there are no medicines that are 100% effective and without side effects.

The cost of Fumaderm I was told by my dermatologist was around £2 a tablet maximum £12 a day on full dose £4380 per year if you take full dose for a year which would be unusual .....but this last year I have no idea of current price

[pingu]

You are partly wrong Pingu.
Next to methotrexate is Dimethylfumarate with an effectiveness of 70%. And it has the enormous advantage that it is way less toxic than MTX.
Fumaderm is though more expensive. But for me it is my health I am thinking about, which is an important factor in the choice of medication.

Surely it would be nice to create and build up a list with effective medications.

As far as I know there are no medicines that are 100% effective and without side effects.

Indeed this is why I am asking, I also like multiple sources of reference. This was from what my dermatologist told me. I think costs wold be variable as well but if we defined a treatment as low, medium or high cost. I do know that my derm didn't mention Dimethylfumarate, alternatives to MTX began with a c and an f if I recall. Obviously I was paying less attention then as well as knowing a lot less. And I still know nothing!

[Caroline]

You are partly wrong Pingu.
Next to methotrexate is Dimethylfumarate with an effectiveness of 70%. And it has the enormous advantage that it is way less toxic than MTX.
Fumaderm is though more expensive. But for me it is my health I am thinking about, which is an important factor in the choice of medication.

Surely it would be nice to create and build up a list with effective medications.

As far as I know there are no medicines that are 100% effective and without side effects.

Indeed this is why I am asking, I also like multiple sources of reference. This was from what my dermatologist told me. I think costs wold be variable as well but if we defined a treatment as low, medium or high cost. I do know that my derm didn't mention Dimethylfumarate, alternatives to MTX began with a c and an f if I recall. Obviously I was paying less attention then as well as knowing a lot less. And I still know nothing!

He probably said Fumaderm, but the working ingredient is Dimethylfumarate. That is how it is referred to in the Netherlands, as you than have the possibility to choose from different variants over here in NL.

The top-dermatologist in NL, dr. van de Kerkhoff, is now experimenting with combinations of DMF and Biologicals.

[Fred]

Thanks Fred

Would it be realistic to go from MTX to stelara? What are the side effects? Would my derm be looking at other treatments before going to stelara.

Yes it would be realistic and is becoming more of the first Bio's after failing on the oral treatments. It has a good track record and is no more expensive than the other Bio's.

As for the side effects you can read most of them here: Stelara (ustekinumab) as you know there are side effect with everything, but in my 6 years on it the worst I've had was some headaches and cold/flu like feelings when I first started it but they were mild and my body soon got used to it. Now I tend to feel a little tired after my shot for a couple of days, but I'm on 95mg.

Obviously though you are going to get answers that are going to be 100% biased. I would recommend you go onto Stelara and push like hell to get it. And the DMF gang will advise you to go their way, the only thing with that is Fumaderm isn't available in all areas of the UK.

Stop popping the poison, and go for 1 simple injection under the skin every 12 weeks and enjoy life. No brainer mate.

At the end of the day you can ask these sort of questions and you will get honest answers, but I would say do your homework and remember there is no one suits all. Go through all the information here by al means and ask away, but it's your body and you will have to decide what is best for you.

I wouldn't take of the oral treatments not even fumaderm even if it was available to me (which it isn't) I hate pills and there is no way I could put up with the stomach problems. I also couldn't go back to Remicade, Enbrel or Humira as I had reactions to them. I go for what is available and what I'm happy taking, I then go by the results and quality of life I'm getting. That's my choice, and I take no notice of what is written in the side effects.

EDIT:

The C would be Ciclosporine you may as well stay on Methotrexate.

The F would be Fumaderm lot's of fans on here.

[pingu]

So far and this is my stab at the psoriasis treatment hierarchy we have.

Lotions and potions, creams prescribed by your GP. I am not aware of anyone who has had success with any of these from a clearance perspective only to alleviate some of the symptoms such as redness and itching. (My experience)

In second place I think it would be PUVA (I have never had it and it may be becoming less popular when I think of the overhead against prescribing an oral treatment).

Then we have a first set of low cast oral treatments

• Acitretin
  
• Ciclosporine
  
• Fumaderm (Dimethylfumarate)
  
• Methotrexate
  

Biologics:

• Humira (adalimumab)
  
• Enbrel (etanercept)
  
• Remicade (infliximab)
  
• Stelara (ustekinumab)
  
• Simponi (golimumab)
  
• Cimzia (certolizumab pegol)
  
• Cosentyx (secukinumab)
  
  
  
  OK two things I don't know how to do hyperlinks! Fred feel free to add if you can!
  
  Fred I hate taking drugs of any description as well BUT, it is a lot easier at the moment than creams every day. I realise this is a journey so I may not get stelara anytime soon but at least I can open negotiations with my derm.

[jiml]

Fred wroteI wouldn't take the oral treatments not even fumaderm even if it was available to me (which it isn't) I hate pills and there is no way I could put up with the stomach problems. I also couldn't go back to Remicade, Enbrel or Humira as I had reactions to them. I go for what is available and what I'm happy taking, I then go by the results and quality of life I'm getting. That's my choice, and I take no notice of what is written in the side effects

Just a brief answer to that....for me and for many others the stomach problems last a couple of months with Fumaderm as your body gets used to the intrusion, since then and for around four years I have had no side effects to speak of apart from the occasional flush
Yes it is your choice but I will steer clear of biological drugs for as long as possible for no other reason than Fumaderm fits my lifestyle, I eat what I like, I drink as much as I want I have as much or more energy than I have ever had, I don't ever suffer with tiredness or hangovers, I don't get infections any more often than the general population

But it's horses for courses and it's for everyone to read as much as possible and make a decision based on their own circumstances......I'm sure had I been put on a bio drug that worked before I went on Fumaderm I would probably be as passionate about it as I am about Fumaderm