What Are Systemic Medications?
Reviewed by: HU Medical Review Board | Last reviewed: June 2022. | Last updated: March 2023
Psoriasis is an autoimmune condition characterized by an overactive immune response. This increased immune system activity leads to inflammation in the body, which triggers the production of new skin cells at a rate too fast for the older skin cells to be shed.
The skin cells build up and form symptoms called plaques on the skin, which can range from mild to severe. It is important to note that the sections below do not include all side effects of its mentioned medication.
The role systemic medications play in psoriasis treatment
While psoriasis is a chronic, long-term condition, there are many treatment options to help manage symptoms, such as topical medications, phototherapy, and systemic medications.
Systemic medications are powerful treatments that affect the whole body and not just the skin. Since systemic treatments often have significant side effects, they are typically used for people with moderate-to-severe psoriasis with symptoms that cannot be controlled well enough with topical medications applied directly to the skin1.
What are the different types of systemic medications for psoriasis?
Systemic medications are either taken orally or through injection into the skin or muscle2. Systemic medications are medications that work throughout the whole body. Systemic medications differ from biologics, which are bioengineered proteins that mimic functions or target specific cells or proteins in the body.
Systemic medicines for psoriasis are:
- Methotrexate
- Soriatane (acitretin)
- Sandimmune (cyclosporine)
- Otezla (apremilast)
What is methotrexate?
Methotrexate is a type of systemic medication known as an antimetabolite. Methotrexate is taken once a week by mouth or injection and works by interfering with cell reproduction and reducing inflammation. It is the primary systemic drug used to treat those with severe psoriasis1.
As with many systemic medications, methotrexate is associated with serious side effects. These include higher risk of infection, kidney damage, coughing or shortness of breath, severe anemia, and bone marrow issues. Liver damage is the most serious risk and thus patients with liver problems are unlikely to be given methotrexate2. Additionally, in those with alcoholism, certain blood conditions, kidney problems, active infections, peptic ulcers, or a suppressed immune system may not be able to take methotrexate. Patients treated with methotrexate usually have regular blood and laboratory test in order to watch for harmful effects the drugs may have on their bodies3.
Read more information about methotrexate.
What is Soriatane (acitretin)?
Soriatane is the brand name of the systemic medication acitretin.
It is a type of drug known as an oral retinoid (a form of synthetic vitamin A) and works by controlling the production of new skin cells and reducing the overactive inflammatory response associated with psoriasis1. Soriatane is taken orally in pill form and can take several months before symptoms improve.
Taking Soriatane comes with some risks and side effects2. Those who are pregnant should not take Soriatane as it is associated with serious birth defects. Those who wish to become pregnant should wait a minimum of three years before conceiving after taking Soriatane.
Some side effects include hair loss, dry skin, increased sensitivity to sunlight, headache, changes in liver function, and mood change. These side effects, however, can often be resolved by changing the dosage of the medication.
Read more information about Soriatane.
What is cyclosporine?
Sandimmune and Neoral are the brand names for medications that contain the active ingredient cyclosporine.
Sandimmune is one of the primary systemic medications used in the treatment of more severe types of psoriasis1. It is classified as an immunosuppressant drug and works by reducing or blocking certain immune system factors that cause the inflammation in psoriasis.
Some common and temporary side effects for the medication include tiredness, gout, headache, tremors, and diarrhea. When taking cyclosporine there is an increased risk of kidney damage, high blood pressure, lymphoma, or skin cancer2.
Those with active infections or cancer should not take cyclosporine as well as patients with uncontrolled high blood pressure, kidney problems, or those who are currently pregnant or breastfeeding.
Read more information about cyclosporine.
What is Otezla (apremilast)?
Otezla is an oral systemic medication for those with moderate to severe plaque psoriasis. Its active ingredient, apremilast, works by targeting certain inflammation-causing cells inside the body and reducing the activity of the immune system that causes inflammation3.
The most common side effects when taking Otezla are diarrhea, nausea, and headache that generally go away with time on the medication4.
Read more information about Otezla.
