Although methotrexate is generally well-tolerated and efficacious in the treatment of psoriasis, it is even more effective, with fewer reported adverse effects, among patients with psoriasis but without psoriatic arthritis, compared with those with both, according data published in JAMA Dermatology.
“Methotrexate has been used as a first-line treatment for moderate to severe psoriasis for more than 50 years,” Kexiang Yan, MD, PhD, of Huashan Hospital at Fudan University in Shanghai, and colleagues wrote. “To our knowledge, a prospective, comparative study of the efficacy and adverse effects of methotrexate in Chinese patients with psoriasis with and without psoriatic arthritis has not yet been performed.”
To determine the effectiveness and safety of methotrexate in patients with psoriasis but without PsA, Yan and colleagues conducted a prospective, single-arm, interventional study of patients at Fudan University’s Huashan Hospital. From April 1, 2015, to Dec. 31, 2017, the researchers enrolled 235 patients with psoriasis who were treated with methotrexate, including 128 with PsA and 107 without.
The initial oral methotrexate regimen was 7.5 mg to 10 mg once weekly, which, based on the patients’ clinical response, was increased by 2.5 mg every 2 to 4 weeks, to a maximum of 15 mg weekly. The intervention course lasted 12 weeks. The primary outcomes included changes in disease severity, adverse events, blood cell counts, and liver and renal function.
According to the researchers, 3.1% of patients with PsA achieved 90% reductions from baseline Psoriasis Area Severity Index scores by week 8, compared with 11.2% those without psoriatic arthritis (P=.02). By week 12, 14.8% of patients in the PsA group had achieved 90% reductions, compared with 25.2% of those without (P=.049). In addition, incidence rates of adverse events were significantly higher in patients with PsA than in those with psoriasis only.
Regarding adverse effects, 9.4% of patients with PsA experienced dizziness compared with 0.9% of those with psoriasis only (P=.007). In addition, 25% of those with PsA demonstrated gastrointestinal symptoms compared with 12.1% without (P=.01), while 26.6% had hepatoxicity compared with 15% in the psoriasis-only group (P=.04).
“Our study demonstrated that methotrexate was well tolerated by Chinese outpatients with psoriasis,” Yan and colleagues wrote. “Methotrexate appeared to be more effective and had fewer adverse effects in patients without psoriatic arthritis compared with those with psoriatic arthritis. Although multicenter trials with larger sample size are needed to confirm these results, our findings suggest that methotrexate can be recommended as first-line treatment for psoriasis without arthritis.” – by Jason Laday
Disclosure: Yan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.