title: Adverse events from systemic therapies for psoriasis are common in clinical practice.
abstract: BACKGROUND
  Patients with moderate-to-severe psoriasis frequently require systemic treatment and these medications may be associated with adverse effects. Little is known about the frequency of these events when systemic agents are used in true clinical practice.
  
  
  OBJECTIVE
  To determine the frequency of adverse events associated with various systemic psoriasis therapies.
  
  
  METHODS
  A retrospective chart review of 753 patients treated in an academic dermatology practice was performed to identify the frequency of adverse events. Poisson regression was used to estimate the odds of significant events for each systemic therapy; UVB-treated patients served as a control population.
  
  
  RESULTS
  Methotrexate seemed to be the most prescribed medication. Adverse events were noted with all forms of systemic psoriasis therapy. The highest event rate was seen with oral retinoids, though most of these were considered minor (64%). Cyclosporine had the highest significant adverse event rate (0.9 events/patient). For 'significant' adverse events, oral agents had an adjusted odds ratio>6 compared to standard UVB therapy. The highest risk was for cyclosporine (OR = 20.3); however, the estimate was imprecise (95% confidence interval [4.3, 96.6]).
  
  
  CONCLUSIONS
  Traditional psoriasis therapies are associated with significant adverse events in some patients despite toxicity-sparing approaches such as combination therapy. Clinicians need to be aware of screening for adverse events in order to best ensure the safety of their patients and to maximize the efficacy of a given agent. There is still a need for the development of safe and effective treatments for patients with moderate-to-severe psoriasis.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pearce
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Higgins
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Stealey
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Martin M
authors.initials: MM
authors.lastname: Crane
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D001688:Biological Products / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006918:Hydroxyurea / Q000009:adverse effects; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects; D011565:Psoriasis / Q000628:therapy*; D012176:Retinoids / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents; D012176:Retinoids; D016572:Cyclosporine; D006918:Hydroxyurea; D008727:Methotrexate