Fumaric acid esters for psoriasis, can Cetirizine help with adverse effects ?

[Fred]

Fumaric acid esters (FAEs) are being used more as safe form of treatment for psoriasis, but 30–40% stop using it due to adverse effects. This small study looked at the use of cetirizine, an oral histamine-1 receptor antagonist as way of reducing those adverse effects.

Quote:

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Background:
Fumaric acid esters (FAEs) are considered an effective and safe long-term treatment for psoriasis. However, 30–40% of patients need to discontinue FAE treatment due to intolerable adverse events.

Objectives:
To assess whether the addition of cetirizine, an oral histamine-1 receptor antagonist, to FAEs would reduce the incidence of adverse events.

Methods:
In a randomized, double-blind, placebo-controlled trial, patients with psoriasis with a Psoriasis Area and Severity Index ≥ 10 starting an FAE up to a dose of dimethylfumarate 720 mg per day were randomized 1 : 1 to receive either additional cetirizine 10 mg once daily (n = 25) or placebo (n = 25) for 12 weeks. Randomization and treatment allocation were done at our hospital trial pharmacy. Primary outcomes were the incidence of adverse events and the proportion of patients discontinuing treatment.

Results:
Fifty patients (33 male, 17 female; median age 44 years) were enrolled. Addition of cetirizine did not reduce the incidence of adverse events compared with placebo (84% vs. 84%, P = 1·00). The types of adverse events were not different between the cetirizine and placebo groups, the most common being gastrointestinal complaints (68% vs. 64%) and flushes (60% vs. 48%). The proportion of patients discontinuing treatment was not statistically different between the cetirizine and placebo groups (24% vs. 32%, P = 0·53).

Conclusions:
Addition of oral cetirizine 10 mg once daily to FAE treatment did not reduce adverse events in patients with psoriasis during the first 12 weeks of treatment. The mechanisms underlying FAE-induced gastrointestinal and flushing symptoms likely involve mediators other than histamine.

Source: NO LINKS ALLOWED

*Early view, no funding declared.

[jiml]

Fumaric acid esters (FAEs) are being used more as safe form of treatment for psoriasis, but 30–40% stop using it due to adverse effects. This small study looked at the use of cetirizine, an oral histamine-1 receptor antagonist as way of reducing those adverse effects.

Quote:

---

Background:
Fumaric acid esters (FAEs) are considered an effective and safe long-term treatment for psoriasis. However, 30–40% of patients need to discontinue FAE treatment due to intolerable adverse events.

Objectives:
To assess whether the addition of cetirizine, an oral histamine-1 receptor antagonist, to FAEs would reduce the incidence of adverse events.

Methods:
In a randomized, double-blind, placebo-controlled trial, patients with psoriasis with a Psoriasis Area and Severity Index ≥ 10 starting an FAE up to a dose of dimethylfumarate 720 mg per day were randomized 1 : 1 to receive either additional cetirizine 10 mg once daily (n = 25) or placebo (n = 25) for 12 weeks. Randomization and treatment allocation were done at our hospital trial pharmacy. Primary outcomes were the incidence of adverse events and the proportion of patients discontinuing treatment.

Results:
Fifty patients (33 male, 17 female; median age 44 years) were enrolled. Addition of cetirizine did not reduce the incidence of adverse events compared with placebo (84% vs. 84%, P = 1·00). The types of adverse events were not different between the cetirizine and placebo groups, the most common being gastrointestinal complaints (68% vs. 64%) and flushes (60% vs. 48%). The proportion of patients discontinuing treatment was not statistically different between the cetirizine and placebo groups (24% vs. 32%, P = 0·53).

Conclusions:
Addition of oral cetirizine 10 mg once daily to FAE treatment did not reduce adverse events in patients with psoriasis during the first 12 weeks of treatment. The mechanisms underlying FAE-induced gastrointestinal and flushing symptoms likely involve mediators other than histamine.

Source: NO LINKS ALLOWED

*Early view, no funding declared.

Well that's one not to recommend people try
The positive to take from this is that at least someone is looking at the problem and eventually will find something suitable

[Fred]

Well that's one not to recommend people try
The positive to take from this is that at least someone is looking at the problem and eventually will find something suitable

Yes I think if they could come up with something to combat the adverse effects more people would try it, 30–40% giving up is a shame and to be honest does put me off a little.  

[jiml]

Well that's one not to recommend people try
The positive to take from this is that at least someone is looking at the problem and eventually will find something suitable

Yes I think if they could come up with something to combat the adverse effects more people would try it, 30–40% giving up is a shame and to be honest does put me off a little.  

Yes it can be off putting but remember the side effects are more manageable if you have been on this site and can get advice on when and how to take them. We have had more success stories with Fumaderm than failures ...I think we have had three members who couldn't tolerate the effects. And something to ease the cramps and flushes would be very welcome.
You will notice most don't give up because of lack of efficacy but because of the side effects, and that is a shame

[Fred]

Yes it can be off putting but remember the side effects are more manageable if you have been on this site and can get advice on when and how to take them. We have had more success stories with Fumaderm than failures ...I think we have had three members who couldn't tolerate the effects. And something to ease the cramps and flushes would be very welcome.
You will notice most don't give up because of lack of efficacy but because of the side effects, and that is a shame

Agree it is a shame as it does seem to work well, Yourself, Caroline, and Bill are testament to that. There are going to be side effects of all types of treatments, and some of us will get them and some will not.

For me it comes down to the unpleasant effects and I suppose that is what has happened to the 30–40% drop off rate, I can put up with the odd headache or flu like feeling from Bio's but getting stomach problems and the squits are a bit less easy to tolerate for me personaly.

My time looks like it's coming to have to start looking at another option, and although I read good reports here I can also find bad ones too and that is the good thing about Psoriasis club (It's people giving their honest opinion) and it helps me as a patient with my decision.

Those that are happy will always back up their experience just like I have done with Stelara, but now it looks like it's failing and I'm giving my opinion on its efficacy in my thread. So I'm looking at alternatives and threads like this help.

If only a few more would keep updating their threads here, even once a year could help others as opposed to reading studies.

[Caroline]

Fumaric acid esters (FAEs) are being used more as safe form of treatment for psoriasis, but 30–40% stop using it due to adverse effects. This small study looked at the use of cetirizine, an oral histamine-1 receptor antagonist as way of reducing those adverse effects.

Quote:

---

Background:
Fumaric acid esters (FAEs) are considered an effective and safe long-term treatment for psoriasis. However, 30–40% of patients need to discontinue FAE treatment due to intolerable adverse events.

Objectives:
To assess whether the addition of cetirizine, an oral histamine-1 receptor antagonist, to FAEs would reduce the incidence of adverse events.

Methods:
In a randomized, double-blind, placebo-controlled trial, patients with psoriasis with a Psoriasis Area and Severity Index ≥ 10 starting an FAE up to a dose of dimethylfumarate 720 mg per day were randomized 1 : 1 to receive either additional cetirizine 10 mg once daily (n = 25) or placebo (n = 25) for 12 weeks. Randomization and treatment allocation were done at our hospital trial pharmacy. Primary outcomes were the incidence of adverse events and the proportion of patients discontinuing treatment.

Results:
Fifty patients (33 male, 17 female; median age 44 years) were enrolled. Addition of cetirizine did not reduce the incidence of adverse events compared with placebo (84% vs. 84%, P = 1·00). The types of adverse events were not different between the cetirizine and placebo groups, the most common being gastrointestinal complaints (68% vs. 64%) and flushes (60% vs. 48%). The proportion of patients discontinuing treatment was not statistically different between the cetirizine and placebo groups (24% vs. 32%, P = 0·53).

Conclusions:
Addition of oral cetirizine 10 mg once daily to FAE treatment did not reduce adverse events in patients with psoriasis during the first 12 weeks of treatment. The mechanisms underlying FAE-induced gastrointestinal and flushing symptoms likely involve mediators other than histamine.

Source: NO LINKS ALLOWED

*Early view, no funding declared.

Well that's one not to recommend people try
The positive to take from this is that at least someone is looking at the problem and eventually will find something suitable solution.

Jim it is already there !!!!
"Slow release" solves most of the problems!

[Caroline]

Well that's one not to recommend people try
The positive to take from this is that at least someone is looking at the problem and eventually will find something suitable

Yes I think if they could come up with something to combat the adverse effects more people would try it, 30–40% giving up is a shame and to be honest does put me off a little.  

Oh you Pussy. Your fear the things that you only think are there, like most children do as they think there are ghosts under their beds.
The solution is long there and I use it already for long time.

Even the guys of Biogen are in that way with their product for MS.

[Fred]

Oh you Pussy. Your fear the things that you only think are there, like most children do as they think there are ghosts under their beds.
The solution is long there and I use it already for long time.

Even the guys of Biogen are in that way with their product for MS.

Thank you Caroline I knew we could rely on you to come up with a Logical answer as to why 30–40% give up, I'm sure it will be helpful to those that did give up knowing they were only thinking they were experiencing the intolerable adverse events.  

[Caroline]

Oh you Pussy. Your fear the things that you only think are there, like most children do as they think there are ghosts under their beds.
The solution is long there and I use it already for long time.

Even the guys of Biogen are in that way with their product for MS.

Thank you Caroline I knew we could rely on you to come up with a Logical answer as to why 30–40% give up, I'm sure it will be helpful to those that did give up knowing they were only thinking they were experiencing the intolerable adverse events.  

As i already said to Jim. This version I use, the slow release version, is not totally stupid.  
Most of the intestine problems are minimized by it.

Major problem is that  dermatologists, pharma, institutions and insurances are not smart enough to realize that and to read about the problem, all has already been invented.
Apparantly they suffer from the "not in vented here syndrome".

Sure, also with the slow release version there are some people that are so sensitive that they have to quit, but that is far from the 30-40%, maybe 5-10% at most.
And I don't think you are that sensitive.

Additional to that, it makes no sense fearing things that may not at all happen. Fear is your worst enemy. You mustn't quit because others cannot cope with problems, you must quit if you experience that problem yourself. Certainly given the big chance that it may help.
I am not meaning to say that problems may not exist and people do have to quit, that is sad enough, but I want to say that you should grab the 60-70% chance that you don't experience problems, when the time is there.

And if fear is not your worst enemy, I will be that gladly ....

[Fred]

And if fear is not your worst enemy, I will be that gladly ....    

You're the only thing I do fear.