Despite guidelines, systemic corticosteroids prescribed for psoriasis

Although systemic corticosteroid treatment is either discouraged or absent from current management guidelines, researchers found that the drugs are among the common systemic treatments for patients with psoriasis.

“Expert guidelines discourage their use for psoriasis due to concerns about causing flares of generalized pustular psoriasis, but there are no randomized controlled trials of systemic corticosteroids in psoriasis to look at these issues,” researcher Scott A. Davis, MS, assistant direct of the Center for Dermatology Research at Wake Forest Baptist Medical Center, Winston-Salem, NC., said in a press release.

Scott A. Davis, MS 

Scott A. Davis

Davis and fellow researchers determined systemic medications prescribed for psoriasis from 1989 to 2010 through the National Ambulatory Medical Care Survey (NAMSC) data. Analysis of Medicaid data from 2003 to 2007 was used to confirm findings.

Out of 21,020,000 psoriasis visits, 650,000 (3%) were prescribed systemic corticosteroids (95% CI, 380,000-920,000); 93% of the visits resulting in corticosteroid prescriptions were to dermatologists. Three of the top nine systemic medications listed at psoriasis visits were corticosteroids (prednisone, methylprednisolone and dexamethasone).

The use of systemic corticosteroids for psoriasis was not observed to have a significant increase or decrease during the study period (P =.27). There was a slightly higher frequency of systemic corticosteroid use, according to analysis of MarketScan Medicaid data, with prednisone prescribed more frequently than methotrexate or etanercept.

“Psoriasis has an enormous impact on patients’ lives, and there have been major recent advances in treatment,” Davis said. “While the new treatments are higher effective and appear very safe, they are costly; their effects are well studied. In contrast, while corticosteroids have been available for decades, their use in psoriasis has not been extensively studied.”

“Data are acutely needed on the risks and benefits [of systemic corticosteroids] so that physicians and patients can make evidence-based decisions about their use,” the researchers concluded.

 

Disclosure: See the study for a full list of relevant financial disclosures.