Acitretin (Soriatane) for psoriasis
People whose psoriasis cannot be controlled by topical medications applied directly to affected areas of the skin may turn to systemic, or internally administered, drugs, to ultraviolet light treatments, to biologic therapies, or to some combination of them. In the United States, the three most common systemic medications for psoriasis are cyclosporine, methotrexate, and acitretin (Soriatane). This page discusses acitretin.
What is it?
Acitretin belongs to a class of drugs called retinoids, which are derivatives of vitamin A. It received FDA approval in 1996 and currently is the only orally administered retinoid approved for the treatment of psoriasis in the United States. A closely related retinoid, etretinate (Tegison), was used to treat psoriasis, but was withdrawn from the U.S. market in 1998. A third retinoid, isotretinoin (Accutane), is primarily used to treat severe acne. It is less effective against psoriasis than acitretin, but is still prescribed in some cases.
How is it administered?
Acitretin is usually taken in pill form once a day.
How well does it work?
There is a lot of variability in study results, but acitretin appears to be somewhat less effective than cyclosporine or methotrexate at controlling plaque psoriasis, the most common form of the disease. Acitretin clears psoriasis completely in about 30% of patients and improves symptoms significantly in another 50%. Many patients get the best results by combining acitretin with PUVA. The drug is also especially beneficial for patients with pustular or erythrodermic psoriasis.
Aside from the fact that it causes serious birth defects (see below, Drawbacks), acitretin is a relatively safe medication. Unlike cyclosporine and methotrexate, acitretin usually does not cause cumulative organ damage, so in patients who can reliably avoid pregnancy, it can be a good long-term maintenance therapy. For example, patients can take acitretin during the gaps between short courses of cyclosporine treatment. Acitretin is also the only one of the three systemic therapies that does not suppress the immune system, so patients with immunodeficiency disorders, such as HIV infection, can use it. Finally, acitretin is particularly effective against pustular and erythrodermic psoriasis and is considered a first choice treatment for patients with those rarer forms of the disease.
Acitretin causes severe birth defects and can be converted to a form that takes a very long time to clear from the body. Therefore, female patients must absolutely avoid pregnancy while taking the drug and for three years after stopping treatment. Because alcohol consumption promotes the conversion of acitretin to the long-lasting form, women of child-bearing age are advised not to drink any alcohol while taking acitretin.
In many patients, acitretin use leads to an increase in triglyceride levels in the blood, a risk factor for heart attacks. Triglyceride levels should be monitored during treatment and acitretin is not recommended for patients with pre-existing abnormal triglyceride levels. Because of rare reports of serious effects on the liver, liver function should also be monitored.
Acitretin also commonly causes hair loss; hair grows back after stopping treatment.
How does it work?
It is not yet clear how acitretin controls psoriasis. In general, retinoids activate molecules in cell nuclei called retinoic acid receptors. The active receptors regulate the output of many different genes, which influence cellular behavior in complex ways. Retinoids have been shown to reduce inflammation and affect the division rate of cells in the skin. A better understanding of how retinoids work will hopefully lead to the development of more specific and effective psoriasis medications.
The company that markets this treatment is among those that have programs to help people afford their treatments. Learn more here: Psoriasis Prescription Payment Assistance Programs.