Psoriasis

Psoriasis treatments: non-biological systemic medicines

Many types of non-biological systemic medicine can be used for psoriasis. Different systemic medicines may be tried at different times and the risks as well as benefits should be considered. Cyclosporine and methotrexate are two non-biological systemic treatments for psoriasis (see also the overview on systemic treatments). Both medicines work in different ways by slowing down the skin cell production and reducing inflammation. They are usually taken as tablets, but can also be given as injections.

Five people we talked to had taken cyclosporine (Zara, Lucy, Hannah, Lisa, Sofia) and five people had tried methotrexate (Zara, Lucy, Hannah, Lisa, Megan). Everyone had taken their medicines in tablet form and Hannah had also tried methotrexate injections. Some people had tried a medicine several times at different points in their psoriasis treatment: Lisa took cyclosporine for 1 year, then methotrexate for 6 months, went back to cyclosporine for 1 month, stopped medication when living abroad and back to methotrexate when she returned to the UK. Lucy’s taken cyclosporine and methotrexate in the past, but doesn’t like “pumping my body full of medicine”. She prefers phototherapy as a psoriasis treatment. 

Cyclosporine (also spelt ciclosporin)

Cyclosporine was the first systemic medicine for psoriasis Lucy and Lisa took, after trying other treatments like steroid creams. It was the only systemic medicine Sofia had tried. People took their cyclosporine in tablet form daily. Sofia remembers her dose was two cyclosporine tablets a day. Zara said she found it easier to swallow cyclosporine tablets even though they’re bigger in size than methotrexate tablets.

Some people found cyclosporine helped their psoriasis. Lucy took cyclosporine whilst at college which she says helped her psoriasis a lot. She took it for six months but worried the whole time about plaques coming back. Zara says cyclosporine worked well for three months but then her psoriasis went back to the way it was before. She stopped taking cyclosporine when her doctors offered phototherapy. 

Several people had unpleasant side effects when taking cyclosporine. For Hannah and Sofia, the side effects were the reasons why they stopped taking cyclosporine. People talked about:
  • headaches
  • feeling nauseous (sick, queasy)
  • losing their appetite
  • stomach pains, including cramps and digestive problems – Sofia says it felt like the tablets got “stuck in my stomach”
  • hot flushes
  • itchier skin
  • difficulty sleeping
  • tiredness
  • mood swings (see also emotional impacts)
Louie has a family history of lymphoma (cancer of the lymph glands) and he would be at greater risk of getting it if he took cyclosporine. He plans to start methotrexate instead and is hopeful about this treatment.

Methotrexate

Methotrexate is a systemic medicine usually taken only once a week, either as a tablet or as an injection. Megan’s mum reminded her to take her methotrexate every week. The dose of methotrexate varies but the person may have to swallow several tablets on the day of the week that they take their medicine. Zara didn’t like this: “I couldn’t swallow them I always felt like they were going to dissolve and not taste nice”. Lisa takes folic acid tablets on the other six days of the week. She takes these tablets at the same time each day so she doesn’t forget.

Some people found methotrexate helped their skin. Hannah says it controlled her psoriasis well most of the time she was at university but then “plateaued”. Lisa says she’s also “glad” methotrexate can help with psoriatic arthritis which she thinks she could develop in the future. Zara didn’t find methotrexate made much of a difference to her psoriasis. 

Not everyone had side effects from methotrexate, but some said they did. These included:
  • headaches
  • feeling nauseous (sick and queasy)
  • losing their appetite

Other downsides mentioned were:
  • having to go for regular blood tests
  • being unable to drink alcohol whilst taking the medicine which was a particular concern for those taking methotrexate while at university, like Lucy 
  • having to avoid eating/drinking foods high in potassium (e.g. grapefruit), as this can interact with cyclosporine and methotrexate
  • risks of fetal anomalies (for both men and women) which meant the person taking methotrexate shouldn’t become pregnant or impregnate another. Lisa’s doctors have told her to be very careful and use multiple forms of contraception

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