The sequelae of razoxane therapy

Razoxane has been used in the treatment of severe psoriasis for 7 years. We have reviewed 30 of the psoriatic patients recorded by Atherton et al. (1980) 1 year after withdrawal of this drug because of reported carcinogenesis (Horton, MacDonald & Wells, 1983; Horton et al. , 1983). Four patients have developed acute myeloid leukaemia which has been fatal in three. Asymptomatic haematological abnormalities present during therapy have persisted in a further two subjects. Another two have prematurely developed multiple cutaneous squamous cell carcinomata. Following withdrawal of therapy, various psychological problems were encountered including depression, aggressive behaviour, the refusal to stop therapy, and in one case the threat of suicide. All patients relapsed within 3 months of withdrawal, 10 (38%) required hospital admission. Initially only conventional topical therapy was employed, but with adequate control in only two patients (8%). Subsequently etretinate in an average oral dose of 50 mg was administered to 24 patients (73%). Of these nine patients (37%) were satisfactorily controlled and 15 (58%) deteriorated. Of the latter group, some have remained poorly controlled on retinoids or topical treatment, while alternative cytotoxics have recently been introduced in some cases. In a questionnaire completed by the patients, seven (27%) expressed a desire to restart razoxane despite full knowledge of its potential adverse consequences.