Worrying May Hamper Psoriasis Treatment: Study

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Worrying May Hamper Psoriasis Treatment: Study

Thu Jul 3, 5:39 PM ET

NEW YORK (Reuters Health) - Psoriasis patients who worry excessively

may experience a slower response to light therapy treatment, new study

findings suggest.

Psoriasis is a sometimes-painful skin disorder thought to be caused by

an abnormal immune response. The disease is marked by patches of red,

raised skin covered with silvery scales, and affects about two percent

of the world's population.

In the study, Dr. Donal G. Fortune of the University of Manchester in

the UK and colleagues assessed psychological distress and disease

severity among a group of 112 patients undergoing light therapy for

psoriasis.

The findings are published in a recent issue of the journal Archives of

Dermatology (news - web sites).

During the treatment, known as PUVA, patients are given the

photosensitizing drug psoralen and exposed to ultraviolet A light.

Patients who were classified as " high-level " worriers took about twice

as long to get an improvement in symptoms as those who were " low-level "

worriers, the authors report.

Excessive worrying has a " significant and detrimental " effect on

treatment outcome in patients with psoriasis, they conclude.

As a result, Fortune's team suggests that patients seeking psoriasis

treatment who tend to worry a lot may benefit from psychological

therapy.

In another psoriasis study, published in the same journal, an

international team of researchers reported that a drug that blocks the

effects of certain immune system cells may be a safe and effective

treatment for the chronic skin condition.

" We now have a therapy that is quite effective and safer than some of

the other treatments available for psoriasis, " said lead author Dr.

Mark Lebwohl of the Mount Sinai School of Medicine in New York City.

The new drug, alefacept, is made by Biogen Inc., which funded the

study. The drug was approved by U.S. regulators in January as the first

biologic agent to combat psoriasis.

The authors have served as investigators for Biogen, and Lebwohl is a

consultant for the company.

Mild cases of psoriasis can be treated with topical medication, but

more serious cases, in which lesions cover more than 10 percent of the

body, require treatment with ultraviolet radiation or immunosuppressive

drugs. These therapies cannot be used over the long term, however, due

to an increased risk of cancer.

Alefacept binds to immune system cells called T lymphocytes and

prevents their activation. Studies have shown that these cells play an

important role in causing the skin abnormalities, or lesions, that are

characteristic of psoriasis.

The study included 507 adults with a common form of psoriasis.

Drugs were administered by injection into the thigh once a week for 12

weeks and patients were monitored for an additional 12 weeks after

treatment. The participants received either 15 milligrams (mg) or 10 mg

of alefacept or a placebo.

Psoriasis severity was reduced a maximum of 46 percent, 41 percent and

25 percent for the 15 mg, 10 mg and placebo groups, respectively.

Symptom improvement remained even twelve weeks after treatment ended,

the authors add.

Three months of treatment provide about seven months of remission,

Lebwohl told Reuters Health.

The drug did not cause any serious side effects, he noted.

The current findings show that a shot of alefacept in the thigh is

effective and that the drug provides patients with " a duration of

remission that exceeds most treatments we have, " said Lebwohl.

" Since treatment with alefacept clears disease in only about one third

of patients and its onset of action is slow, it will be important to

study the efficacy, time until onset of clearance and safety of

alefacept in combination " with other drugs, Dr. Alice Gottlieb of the

University of Medicine and Dentistry of New Jersey- Wood

Medical School in New Brunswick writes in an accompanying editorial.

Gottlieb is an investigator, consultant or speaker for several

companies, including Biogen, Amgen, Wyeth, Novartis, Centocor Inc.,

Genentech Inc. and Xoma Corp.

SOURCE: Archives of Dermatology 2003;139:719-727,752-756,791-793