A Review of the Efficacy and Safety of Combined Methotrexate and Ultraviolet B Phototherapy versus Ultraviolet B Phototherapy Alone in the Treatment of Psoriasis

Abstract

Background Methotrexate (MTX) and ultraviolet light B (UVB) phototherapy are effective as single agents for psoriasis. By combining the two agents, it is proposed that the use of UVB-MTX can yield greater therapeutic efficacy than using MTX or UVB alone and limit the cumulative exposure of both UVB and MTX to the patient. Objective To review evidence on the clinical efficacy and safety of using combined UVB-MTX compared with using UVB alone. Methods We performed a PubMed search for studies involving the combination of UV therapy with MTX. The reported studies evaluate the clinical efficacy and safety of UVB-MTX therapy compared with UVB alone. Results Based on the studies we reviewed, combined UVB-MTX therapy is more effective than UVB alone in treating psoriasis. The mean cumulative MTX doses ranged from 112 to 196 mg, and no cases of MTX-related liver toxicity symptoms were reported in the three studies. Discussion Combination phototherapy involving UVB-MTX is more clinically effective than UVB alone for patients with plaque-type psoriasis. The current review is limited by the absence of studies comparing the efficacy of combined UVB-MTX therapy with MTX monotherapy. Combination UVB-MTX therapy appears to be safe and well tolerated.