PMID- 32529393
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240317
IS  - 2193-8210 (Print)
IS  - 2190-9172 (Electronic)
VI  - 10
IP  - 4
DP  - 2020 Aug
TI  - Long-term Safety of Oral Systemic Therapies for Psoriasis: A Comprehensive Review 
      of the Literature.
PG  - 589-613
LID - 10.1007/s13555-020-00409-4 [doi]
AB  - Oral systemic therapies are important treatment options for patients with 
      moderate-to-severe psoriasis, either as monotherapy or in therapy-recalcitrant 
      cases as combination therapy with phototherapy, other oral systemics or 
      biologics. Long-term treatment is needed to maintain sufficient disease control 
      in psoriasis, but continuous use of systemic treatments is limited by adverse 
      events (AEs) and cumulative toxicity risks. The primary aim of this comprehensive 
      literature review was to examine the long-term safety profiles of oral agents 
      commonly used in the treatment of adults with psoriasis. Searches were conducted 
      in EMBASE and PubMed up to November 2018, and 157 relevant publications were 
      included. Long-term treatment with acitretin could be associated with skeletal 
      toxicity and hepatotoxicity, although evidence for skeletal toxicity is mixed and 
      hepatotoxicity is rare, particularly at low doses. Other safety issues include 
      hyperlipidaemia and potential for teratogenicity up to 2-3 years after 
      discontinuation of treatment. There is a paucity of data on long-term treatment 
      with apremilast. Continued exposure to apremilast does not seem to increase the 
      incidence of common AEs, such as gastrointestinal (GI) AEs, upper respiratory 
      tract infections and headache, while the long-term risks for depression, suicidal 
      thoughts and weight loss are unknown. Long-term ciclosporin treatment is 
      associated with renal toxicity, hypertension, non-melanoma skin cancer, 
      neurological AEs and GI AEs. Long-term methotrexate treatment is associated with 
      hepatotoxicity, GI AEs, haematological toxicity, renal toxicity and alopecia. 
      Finally, long-term treatment with fumaric acid esters (FAE) is associated with GI 
      AEs, flushing, lymphocytopenia, proteinuria and elevated liver enzymes. Median 
      drug survival estimates varied considerably: ~  2.9-9.7 months for 
      apremilast; ~ 5.4 months for ciclosporin; ~ 8.6 months for 
      acitretin; ~ 12.1-21.6 months for methotrexate; and ~  54.8 months for FAE. These 
      long-term safety profiles may help to guide clinicians to select the optimal oral 
      systemic treatment for the long-term treatment of psoriasis in adults.
FAU - Balak, Deepak M W
AU  - Balak DMW
AUID- ORCID: 0000-0002-0755-3770
AD  - Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, the Netherlands. 
      balak.dmw@gmail.com.
FAU - Gerdes, Sascha
AU  - Gerdes S
AD  - Department of Dermatology, Psoriasis-Center, University Medical Center 
      Schleswig-Holstein, Campus Kiel, Kiel, Germany.
FAU - Parodi, Aurora
AU  - Parodi A
AD  - DiSSal Section of Dermatology, University of Genoa-Ospedale-Policlinico San 
      Martino IRCCS, Genoa, Italy.
FAU - Salgado-Boquete, Laura
AU  - Salgado-Boquete L
AD  - Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, 
      Pontevedra, Spain.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200611
PL  - Switzerland
TA  - Dermatol Ther (Heidelb)
JT  - Dermatology and therapy
JID - 101590450
PMC - PMC7367959
OTO - NOTNLM
OT  - Adverse events
OT  - Drug survival
OT  - Long-term
OT  - Psoriasis
OT  - Safety
OT  - Systemic therapy
COIS- Deepak M. W. Balak is a consultant/speaker for AbbVie, Almirall, Celgene, Eli 
      Lilly, Janssen, LEO Pharma, Novartis and Sanofi Genzyme, and has received 
      research grants from LEO Pharma. Sascha Gerdes has been an adviser for and/or 
      received speakers' honoraria and/or received grants from, and/or participated in 
      clinical trials for Abbott/AbbVie, Affibody AB, Akari Therapeutics Plc, 
      Almirall-Hermal, Amgen, Anaptys Bio, Baxalta, Bayer Health Care, Biogen Idec, 
      Bioskin, Boehringer Ingelheim, Celgene, Centocor, Dermira, Eli Lilly, Foamix, 
      Forward Pharma, Galderma, Hexal AG, Incyte Inc., Isotechnika, Janssen-Cilag, 
      Johnson & Johnson, Kymab, LEO Pharma, Medac, Merck Serono, Mitsubishi Tanabe, 
      Molnlycke Health Care, MSD, Novartis, Pfizer, Polichem S.A., Principia Biopharma, 
      Regeneron Pharmaceutical, Sandoz Biopharmaceuticals, Sanofi-Aventis, 
      Schering-Plough, Sienna Biopharmaceuticals, Takeda, Teva, Trevi Therapeutics, UCB 
      Pharma, VBL Therapeutics and Wyeth Pharma. Aurora Parodi has received speaker 
      grants from and/or participated in clinical trials for AbbVie, Almirall, Celgene, 
      Galderma, Jannsen-Cilag, LEO Pharma, Lily, Novartis, Pfizer and UCB. Laura 
      Salgado-Boquete has received fees from AbbVie, Almirall, Celgene, Janssen, LEO 
      Pharma, Lilly, Novartis, MSD and Pfizer.
EDAT- 2020/06/13 06:00
MHDA- 2020/06/13 06:01
PMCR- 2020/06/11
CRDT- 2020/06/13 06:00
PHST- 2020/03/25 00:00 [received]
PHST- 2020/06/13 06:00 [pubmed]
PHST- 2020/06/13 06:01 [medline]
PHST- 2020/06/13 06:00 [entrez]
PHST- 2020/06/11 00:00 [pmc-release]
AID - 10.1007/s13555-020-00409-4 [pii]
AID - 409 [pii]
AID - 10.1007/s13555-020-00409-4 [doi]
PST - ppublish
SO  - Dermatol Ther (Heidelb). 2020 Aug;10(4):589-613. doi: 10.1007/s13555-020-00409-4. 
      Epub 2020 Jun 11.