Friday, 21 Sep 2018

You are here

Methotrexate's Low Efficacy in Cutaneous Psoriasis

In a prospective, double-blind, randomized placebo-controlled study, Warren et al. studied the effect of an intensified methotrexate (MTX) in chronic plaque psoriasis and showed MTX to be effective and superior to placebo.  

A total of 120 patients who were MTX-naive adults with active plaque psoriasis patients were randomized to receive 16 weeks of subcutaneous injections of either methotrexate (17.5 mg/wk) or placebo. MTX doses could be escalated to 22.5 mg per week after 8 weeks if patients did not achieve ≥ PASI50% improvement. All patients received folic acid 5 mg per week. 

A PASI 75 response was achieved in 41% of MTX treated but only in 10% of placebo  treated patients (P = 0·0026) by week 16. Subcutaneous methotrexate was generally well tolerated, with no serious adverse events related to this treatment over the 52-week study.

Other analyses and skin biopsies at baseline and week 16 showed MTX clinical effect were mediated by decreases in CD3+ lymphocytes and T helper 17 cell-mediated cytokine transcription.

The authors note that these results are in line with other MTX trials in psoriasis, showing  PASI 75 responses of 36–42% i  3 previous studies using oral methotrexate. Nevertheless, these results are far less than that achieved using biologic therapies, especially the IL-17, IL-23 adn IL-12.23 inhibitors.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Biologic Therapies Improve Work Outcomes in Spondyloarthritis

A study from the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS) shows that biologic use significantly improves work productivity and overall activity impairment.

 

The BSRBR-AS registry analyzed 577 participants who were employed;  28% were started on biological therapy .

BMS Tyk 2 Inhibitor Benefits Psoriasis

The NEJM reports that an oral selecive Tyrosine kinase 2 (TYK2) inhibitor of TYK2 was shown to be superior to placebo in a 12 week trial in patients with active psoriasis.

No Cancer Risk from Psoriatic Arthritis

Inflammmation is a strong risk factor for malignancy. Yet there are mixed results on whether patients with psoriatic arthritis (PsAg) augments the incidence of cancer and all-cause and cause-mortality.

A study from the national British Society for Rheumatology Biologics Register examined the risk of cancer, assessed by standardized incidence ratios (SIRs)  or standardized mortality ratios (SMRs).

Treatments Do Not Increase Infection Risk in Ankylosing Spondylitis

A large Canadian study of the drug use in ankylosing spondylitis (AS) demonstrated no evidence that the risk of serious,  hospitalized infection was influenced by the use of DMARD and/or of tumour necrosis factor inhibitors (TNFi) therapy.

They studied 747 AS patients who initiated TNFI and/or DMARDs between 2001 and 2011 to identify hospitalized infection  coding data and hospital discharge diagnoses.

Dietary Recommendations for Psoriatic Disease

A systematic review by the Medical Board of the National Psoriasis Foundation examined the role of diet in managing adult patients with psoriasis and/or psoriatic arthritis and suggest that dietary interventions to reduce disease severity.

A metanalysis of 55 studies and 4534 patients with psoriasis examined the role of weight loss, gluten-free diets, vitamin supplementation on reducing psoriatic disease activity.