Efficacy
In extensive clinical trials, acitretin has been shown to be effective in treating severe psoriasis both as monotherapy and in combination with other therapies.
Psoriasis – Monotherapy
- Best clinical response obtained in localized or generalized pustular psoriasis and in erythrodermic psoriasis
- In some patients, an initial worsening of the disease may be observed, with an increase in erythema and the extent of lesions.
- Low initial doses of 10 mg/day, progressively increased up to 50 mg/day, can avoid this undesirable effect.
- Multicenter trials show around 75% of patients achieving a PASI 50 response rate and 50% achieving a PASI 75 response rate after 12 weeks of therapy (a 50% or 75% improvement in their baseline Psoriasis Area Severity Index (PASI) score, respectively)
- One third of patients with plaque-type psoriasis attain complete remission with acitretin monotherapy
Psoriasis – Combination Therapy
- Combining therapy with PUVA or UVB increases efficacy and limits treatment frequencies, duration and cumulative doses. This allows for a safer and less costly treatment
- Complete clearing of plaque-type psoriasis may require additional therapy such as topical corticosteroids, topical vitamin D analogues, PUVA or UVB phototherapy
- Can also be combined with a calcipotriol ointment, allowing for a lower total dose of acitretin and improved treatment outcomes
Compliance
- The main issue with compliance is to minimize side effects.
- The drying effects on skin, eyes and muco-cutaneous surfaces is troublesome.
- Starting with a lower dose may ease patients into the side effects.
- Frequent regular moisturizing is a must
- Treating secondary eczema and possible staph infections with appropriate topical medication is needed.
Cost of Treatment
Treatment for 30 days in Canada
- 10 mg daily for 1 month: $64.00
- 25 mg daily for 1 month: $105.00
