Methotrexate in psoriasis treatment: a single-center retrospective study (2018–2020)

Abstract

BACKGROUND: Despite the wide range of therapeutic options for moderate-to-severe psoriasis, dermatologists still experience some difficulties in its treatment. To date, methotrexate (MTX) is the most commonly prescribed systemic drug for the treatment of psoriasis worldwide. Given its low cost and good effectiveness, this drug has been continuously used along with recently developed highly effective biological drugs. According to international guidelines, MTX is a drug of choice for the treatment of moderate-to-severe psoriasis.

AIM: To evaluate the efficacy and safety of MTX in the treatment of moderate-to-severe psoriasis.

MATERIALS AND METHODS: We conducted a retrospective study on patients with psoriasis who had been admitted to the Dermatology Department of Sechenov University in 2018–2020. Based on electronic medical documents of the patients, we analyzed the demographic characteristics, disease duration, comorbidities, psoriasis severity before and after treatment with MTX, and its side effects.

RESULTS: The study included 655 patients with moderate (373; 57%) and severe (282; 43%) psoriasis. Of these patients, 279 (42.6%) were women aged 18–79 years, and 376 (57.4%) were men aged 18–86 years (median age: 44.9 and 41.6 years, respectively). The duration of stay in the hospital varied from 17 days to 21 days. In all cases, topical therapy was performed in addition to systemic drugs administration or phototherapy. The most commonly prescribed medication was MTX 326 (49.7%) in a dose of 25 mg/week. A total of 29 patients received MTX as monotherapy. However, the drug was most often prescribed in combination with phototherapy: MTX + PUVA (n = 140) and MTX + UVB-311 nm (n = 157). At the time of discharge from the hospital, 53% of patients in the MTX group had improved, 47% had a significant improvement. in the MTX group + PUVA – in 10.3; 75.7; 14% of patients, respectively; in the MTX + UVB-311 nm group – in 17.4; 71.2; 11.4% of patients, respectively. The side effects were mild and did not lead to treatment discontinuation.

CONCLUSION: MTX is a highly effective therapeutic option with a good safety profile and is a confirmed drug of choice for the treatment of moderate-to-severe psoriasis.

Keywords

psoriasis / methotrexate / phototherapy / treatment

References

[1] Parisi R, Iskandar I, Kontopantelis E, Augustin M, Griffiths C, Ashcroft D. Global Psoriasis Atlas. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. BMJ. 2020;369:m1590. doi: 10.1136/bmj.m1590

[2] Parisi R., Iskandar I., Kontopantelis E., Augustin M., Griffiths C., Ashcroft D.; Global Psoriasis Atlas. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. BMJ. 2020;369:m1590. doi: 10.1136/bmj.m1590

[3] Springate D, Parisi R, Kontopantelis E, Reeves D, Griffiths C, Ashcroft D. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. 2017;176(3):650-658. doi:10.1111/bjd.15021

[4] Springate D., Parisi R., Kontopantelis E., Reeves D., Griffiths C., Ashcroft D. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. 2017;176(3):650-658. doi: 10.1111/bjd.15021

[5] AlQassimi S, AlBrashdi S, Galadari H, Hashim M. Global burden of psoriasis comparison of regional and global epidemiology, 1990 to 2017. Int J Dermatol. 2020;59(5):566-71. doi: 10.1111/ijd.14864

[6] AlQassimi S., AlBrashdi S., Galadari H., Hashim M. Global burden of psoriasis – comparison of regional and global epidemiology, 1990 to 2017. Int J Dermatol. 2020;59(5):566-71. doi: 10.1111/ijd.14864

[7] Registry of patients with chronic dermatoses. Available at: https://www.cnikvi.ru Accessed: Dec 2020 (in Russian)

[8] Регистр больных хроническими заболеваниями кожи. Доступно на: https://www.cnikvi.ru. Доступ: декабрь 2020

[9] Оlisova OYu. Psoriasis: epidemiology, pathogenesis, clinic, treatment. Consilium Medicum. Dermatology. Russian Journal. 2010;(4):3-8. (in Russian)

[10] Олисова О.Ю. Псориаз: эпидемиология, патогенез, клиника, лечение // Consilium Medicum. Дерматология. 2010;(4):3-8.

[11] Nast A, Amelunxen L, Augustin M, Boehncke WH, Dressler C, Gaskins M, et al. S3 Guideline for the treatment of psoriasis vulgaris, update – Short version part 1 – Systemic treatment. J Dtsch Dermatol Ges. 2018;16(5):645-69. doi: 10.1111/ddg.13516

[12] Nast A., Amelunxen L., Augustin M., Boehncke W.H., Dressler C., Gaskins M., et al. S3 Guideline for the treatment of psoriasis vulgaris, update – Short version part 1 – Systemic treatment. J Dtsch Dermatol Ges. 2018;16(5):645-69. doi: 10.1111/ddg.13516

[13] Chan E, Cronstein B. Methotrexate – how does it really work? Nat Rev Rheumatol. 2010;6(3):175-8.

[14] Chan E., Cronstein B.. Methotrexate – how does it really work? Nat Rev Rheumatol. 2010;6(3):175-8.

[15] Ciesielski C, Pflug J, Mei J, Piccinini L. Methotrexate regulates ICAM-1 expression in recipients of rat cardiac allografts. Transpl Immunol. 1998;6(2):111-21. doi: 10.1016/s0966-3274(98)80026-9

[16] Ciesielski C., Pflug J., Mei J., Piccinini L. Methotrexate regulates ICAM-1 expression in recipients of rat cardiac allografts. Transpl Immunol. 1998;6(2):111-21. doi: 10.1016/s0966-3274(98)80026-9

[17] Sigmundsdottir H, Johnston A, Gudjonsson J, Bjarnason B, Valdimarsson H. Methotrexate markedly reduces the expression of vascular E-selectin, cutaneous lymphocyte-associated antigen and the numbers of mononuclear leucocytes in psoriatic skin. Exp Dermatol. 2004;13(7):426-34. doi: 10.1111/j.0906-6705.2004.00177.x

[18] Sigmundsdottir H., Johnston A., Gudjonsson J., Bjarnason B., Valdimarsson H. Methotrexate markedly reduces the expression of vascular E-selectin, cutaneous lymphocyte-associated antigen and the numbers of mononuclear leucocytes in psoriatic skin. Exp Dermatol. 2004;13(7):426-34. doi: 10.1111/j.0906-6705.2004.00177.x

[19] Warren R, Mrowietz U, Kiedrowski R, Niesmann J, Wilsmann-Theis D, Ghoreschi K, et al. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10068):528-37. doi: 10.1016/ S0140-6736(16)32127-4

[20] Warren R., Mrowietz U., Kiedrowski R., Niesmann J., Wilsmann-Theis D., Ghoreschi K., et al. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10068):528-37. doi: 10.1016/ S0140-6736(16)32127-4

[21] Coates L, Helliwell P. Methotrexate efficacy in the Tight Control in Psoriatic arthritis (TICOPA) study. J Rheumatol. 2016;43(2):356-61. doi: 10.3899/jrheum.150614

[22] Coates L., Helliwell P. Methotrexate efficacy in the Tight Control in Psoriatic arthritis (TICOPA) study. J Rheumatol. 2016;43(2):356-61. doi: 10.3899/jrheum.150614

[23] Ele-Refaei A, El-Esawy F. Effect of narrow-band ultraviolet B phototherapy and Methotrexate on microRNA (146a) levels in blood of psoriatic patients. Dermatol Res Pract. 2015;2015:145769. doi: 10.1155/2015/145769

[24] Ele-Refaei A., El-Esawy F. Effect of narrow-band ultraviolet B phototherapy and Methotrexate on microRNA (146a) levels in blood of psoriatic patients. Dermatol Res Pract. 2015;2015:145769. doi: 10.1155/2015/145769

[25] Carrascosa J, de la Cueva P, Ara M, Puig L, Bordas X, Carretero G, Ferrandiz L, et al. Methotrexate in Moderate to severe psoriasis: Review of the literature and expert recommendations. Actas Dermosifiliogr. 2016;107(3):194-206. doi: 10.1016/j.ad.2015.10.005

[26] Carrascosa J., de la Cueva P., Ara M., Puig L., Bordas X., Carretero G., Ferrandiz L., et al. Methotrexate in Moderate to severe psoriasis: Review of the literature and expert recommendations. Actas Dermosifiliogr. 2016;107(3):194-206. doi: 10.1016/j.ad.2015.10.005

[27] Kaushik S, Lebwohl M. Review of safety and efficacy of approved systemic psoriasis therapies. Int J Dermatol. 2019;58(6):649-58. doi: 10.1111/ijd.14246

[28] Kaushik S., Lebwohl M. Review of safety and efficacy of approved systemic psoriasis therapies. Int J Dermatol. 2019;58(6):649-58. doi: 10.1111/ijd.14246

[29] Cline A, Jorizzo JL. Does daily folic acid supplementation reduce methotrexate efficacy? Dermatol Online J. 2017;23(11):13030/qt4hf5v2vk.

[30] Cline A., Jorizzo J.L. Does daily folic acid supplementation reduce methotrexate efficacy? Dermatol Online J. 2017;23(11):13030/qt4hf5v2vk.

[31] Whiting-O’Keefe QE, Fye KH, Sack KD. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med. 1991;90(6):711-6.

[32] Whiting-O’Keefe Q.E., Fye K.H., Sack K.D. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med. 1991;90(6):711-6.

[33] Howard S, McCormick J, Pui C, Buddington R, Harvey R. Preventing and managing toxicities of high-dose methotrexate. Oncologist. 2016;21(12):1471-82.

[34] Howard S., McCormick J., Pui C., Buddington R., Harvey R. Preventing and managing toxicities of high-dose methotrexate. Oncologist. 2016;21(12):1471-82.

[35] Coates L, Merola J, Grieb S, Mease P, Duffin K. Methotrexate in psoriasis and psoriatic arthritis. J Rheumatol Suppl. 2020;96:31-5. doi: 10.3899/jrheum.200124

[36] Coates L., Merola J., Grieb S., Mease P., Duffin K. Methotrexate in psoriasis and psoriatic arthritis. J Rheumatol Suppl. 2020;96:31-5. doi: 10.3899/jrheum.200124

[37] Cabello Zurita C, Grau Perez M, Hernandez Fernandez C, Gonzalez Quesada A, Valeron Almazan P, Vilar Alejo J, Carretero Hernandez G. Effectiveness and safety of Methotrexate in psoriasis: an eight-year experience with 218 patients. J Dermatolog Treat. 2017;28(5):401-5. doi: 10.1080/09546634.2016.1273469

[38] Cabello Zurita C., Grau Perez M., Hernandez Fernandez C., Gonzalez Quesada A., Valeron Almazan P., Vilar Alejo J., Carretero Hernandez G. Effectiveness and safety of Methotrexate in psoriasis: an eight-year experience with 218 patients. J Dermatolog Treat. 2017;28(5):401-5. doi: 10.1080/09546634.2016.1273469

[39] Tournier A, Khemis A, Maccari F, Reguiai Z, Begon E, Fougerousse AC. GEM Resopso. Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France. Ann Dermatol Venereol. 2019;146(2):106-14. doi: 10.1016/j.annder.2018.11.011

[40] Tournier A., Khemis A., Maccari F., Reguiai Z., Begon E., Fougerousse A.C.; GEM Resopso. Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France. Ann Dermatol Venereol. 2019;146(2):106-14. doi: 10.1016/j.annder.2018.11.011

[41] West J, Ogston S, Foerster J. Safety and efficacy of Methotrexate in Psoriasis: A meta-analysis of published trials. PLoS One. 2016;11(5):e0153740. doi: 10.1371/journal.pone.0153740

[42] West J., Ogston S., Foerster J. Safety and efficacy of Methotrexate in Psoriasis: A meta-analysis of published trials. PLoS One. 2016;11(5):e0153740. doi: 10.1371/journal.pone.0153740

[43] Menting S, Dekker P, Limpens J, Hooft L, Spuls P. Methotrexate dosing regimen for plaque-type psoriasis: A systematic review of the use of test-dose, start-dose, dosing scheme, dose adjustments, maximum dose and folic acid supplementation. Acta Derm Venereol. 2016;96(1):23-8. doi: 10.2340/00015555-2081

[44] Menting S., Dekker P., Limpens J., Hooft L., Spuls P. Methotrexate dosing regimen for plaque-type psoriasis: A systematic review of the use of test-dose, start-dose, dosing scheme, dose adjustments, maximum dose and folic acid supplementation. Acta Derm Venereol. 2016;96(1):23-8. doi: 10.2340/00015555-2081

[45] Montaudie H, Sbidian E, Paul C, Maza A, Gallini A, Aractingi S, et al. Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol. 2011;25(Suppl 2):12-8. doi: 10.1111/j.1468-3083.2011.03991.x

[46] Montaudie H., Sbidian E., Paul C., Maza A., Gallini A., Aractingi S., et al. Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol. 2011;25(Suppl 2):12-8. doi: 10.1111/j.1468-3083.2011.03991.x

[47] Olisova OYu., Andreeva ЕV. Once more about hyperpigmentation. Russian Journal of Skin and Venereal Diseases. 2014;16(4):20-4. (in Russian)

[48] Олисова О.Ю., Андреева Е.В. Еще раз о проблеме гиперпигментации // Российский журнал кожных и венерических болезней. 2014;16(4):20-4.

[49] Otero M, van den Reek J, Seyger M, van de Kerkhof P, Kievit W, de Jong E. Determinants for drug survival of methotrexate in patients with psoriasis, split according to different reasons for discontinuation: results of the prospective MTX-CAPTURE. Br J Dermatol. 2017;177(2):497-504. doi: 10.1111/bjd.15305

[50] Otero M., van den Reek J., Seyger M., van de Kerkhof P., Kievit W., de Jong E. Determinants for drug survival of methotrexate in patients with psoriasis, split according to different reasons for discontinuation: results of the prospective MTX-CAPTURE. Br J Dermatol. 2017;177(2):497-504. doi: 10.1111/bjd.15305

[51] Busard C, Cohen A, Wolf P, Gkalpakiotis S, Cazzaniga S, Stern R, et al. Biologics combined with conventional systemic agents or phototherapy for the treatment of psoriasis: real-life data from PSONET registries. J Eur Acad Dermatol Venereol. 2018;32(2):245-53. doi: 10.1111/jdv.14583

[52] Busard C., Cohen A., Wolf P., Gkalpakiotis S., Cazzaniga S., Stern R., et al. Biologics combined with conventional systemic agents or phototherapy for the treatment of psoriasis: real-life data from PSONET registries. J Eur Acad Dermatol Venereol. 2018;32(2):245-53. doi: 10.1111/jdv.14583

[53] Kozub P, Simaljakova M. Systemic therapy of psoriasis: methotrexate. Bratisl Lek Listy. 2011;112(7):390-4.

[54] Kozub P., Simaljakova M. Systemic therapy of psoriasis: methotrexate. Bratisl Lek Listy. 2011;112(7):390-4.

[55] Garber C, Plotnikova N, Au S, Sorensen E, Gottlieb A. Biologic and conventional systemic therapies show similar safety and efficacy in elderly and adult patients with moderate to severe psoriasis. J Drugs Dermatol. 2015;14(8):846-52.

[56] Garber C., Plotnikova N., Au S., Sorensen E., Gottlieb A. Biologic and conventional systemic therapies show similar safety and efficacy in elderly and adult patients with moderate to severe psoriasis. J Drugs Dermatol. 2015;14(8):846-52.

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