Speed is only one characteristic of a drug which may be of importance -- safety, side effects, cost, and medical reasons why a certain drug can't be used are just a few of the many others. But when time is of the essence, a faster drug may be just what the doctor ordered. Imagine that you're a month away from a cruise and you want to relax by the pool, but feel uncomfortable due to a breakout of psoriasis. That's just the type of situation when you want to get cleared up, fast. Here are a few medications with very rapid onset of action and clearing ability to consider:
Clobex SprayClobex spray is really just clobetasole, a potent corticosteroid, in a spray vehicle. A vehicle is the base in which a drug is mixed; the vehicle delivers the drug to the skin just like UPS' vehicle delivers products to your house. Something about using the drug with the spray vehicle makes it faster than other vehicles. In studies, 8 out of 10 patients with moderate-to-severe plaque-type psoriasis were clear or almost clear after just four weeks of treatment. That's the good news. The bad news is four weeks is the maximum time that you can safely use this drug. After that, you'll need to switch to something else.
I like to use Clobex spray as an adjunct to a slower-acting, but perhaps safer, long-term drug just to initiate a rapid clearing. For example, Clobex spray during the first month of a course of Soriatane or a biologic may give a faster response than the latter drugs alone. After the first month, the Clobex spray is discontinued by which time the slower acting drug has had a chance to kick in.
Side effects of Clobex spray are those of topical corticosteroids including thinning of the skin, stretch marks and faltering of natural production of the hormone cortisol. With the short course approved, these problems are less likely to occur. Clobex spray is not for children, nor for use on the face, on underarms or the groin area.
CyclosporineCyclosporine is more commonly used for organ transplant patients as an anti-rejection drug but is sometimes used in psoriasis. Neoral is a brand of cyclosporine available in both pill and oral-liquid form. Cyclosporine is effective rapidly for psoriasis, with some improvement noted within the first week in many patients. The side effects of the drug are very dose-dependent. In other words, the higher doses that lead to rapid improvement also result in a quicker onset of side effects such as kidney toxicity and hypertension. Psoriasis patients with a history of PUVA treatment have a higher risk of developing skin cancer while using cyclosporine. Biologics, which appear to have a safer risk to benefit ratio compared to cyclosporine, have more or less supplanted this drug for psoriasis in most patients.
HumiraHumira is generally considered the fastest of the lot. It also produces good clearing with more patients being 90% cleared than the competing biologic drugs. Humira was previously approved for psoriatic arthritis at a dose of one injection every other week. When the drug was approved for psoriasis, a dose was added which essentially called for two additional doses of the drug over the first week of treatment. This change greatly accelerated the improvement seen in psoriasis versus the previous dosing schedule.
Humira may increase the risk of severe infection or malignancy. Fortunately, as more and more data comes to light, these risks are appearing to be less worrisome than originally anticipated some years ago.
Better Data Would be HelpfulAlthough the above mentioned drugs seem fast, few studies comparing them to other drugs have been done. Drug companies rarely do comparison studies of their drugs versus another (rather they like to test versus a placebo). So for the time being it's more a matter of perceived speed than hard, cold facts.
Camisa C. Handbook of Psoriasis, 2nd Ed. Blackwell Publishing, USA 2004.