Commentary: three decades of folic acid antagonists in dermatology

Weinstein, Gerald D.

doi:10.1001/archderm.119.6.525

Cited by 8 publications

(6 citation statements)

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“…In our patients, almost 85% showed ≥ 90% clearance of the disease, which is in concordance with previous experience 2 . Total clearance was seen in about two‐fifths of all patients, which is lower than the figure of 61.4% reported by Roenigk et al 15 .…”

Section: Discussionsupporting

confidence: 92%

“…The beneficial effect of folate antagonists on psoriasis was first observed 50 years ago 1 . Since then, methotrexate (MTX) has been the standard treatment for severe forms of psoriasis and its efficacy has been well documented over the years 2 . Although many alternative systemic agents have since been introduced, MTX still remains one of the most efficacious antipsoriatic drugs.…”

Section: Introductionmentioning

confidence: 99%

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Short‐term methotrexate therapy in psoriasis: a study of 197 patients

2002

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Methotrexate (MTX) is one of the most effective antipsoriatic drugs available. Although it is undeniably hepatotoxic, it can be used safely in most patients with severe psoriasis if established guidelines are followed. Current opinion on the monitoring of hepatic damage is divided, however, and the need for repeated liver biopsies during MTX therapy is being re-examined. We have used MTX in a short-term protocol in our patients with psoriasis for the past 20 years, and have recently attempted to minimize or eliminate the need for liver biopsies using this regimen. Data on 244 psoriatics who were given MTX from 1981 to 2000 have been reviewed. Our protocol entailed the use of weekly oral MTX at the full therapeutic dose during episodes of peak disease activity, with tapering off of MTX when the disease subsided in response to treatment combined with natural/seasonal remission. Intensive topical and heliotherapy were encouraged throughout to facilitate the earliest possible drug withdrawal and the longest possible drug-free interval before the next relapse. Strict inclusion criteria were applied before starting MTX. A total of 243 cycles of MTX therapy have been given to 197 evaluable patients. More than 75% improvement occurred in 88% of patients in 8.5 +/- 5.1 weeks. The mean cumulative dose was 709.3 +/- 369.2 mg and the mean duration of follow-up was 16.5 +/- 9.1 months. Fifteen (6.1%) patients had serious adverse effects requiring the cessation of therapy. Only three patients had deranged liver function tests. Thirty-four pre-MTX and 13 post-MTX liver biopsies were taken, which revealed grade I or II changes that were nonprogressive. Our experience with short-term MTX therapy has enabled us to safely administer MTX to our patients with minimal recourse to liver biopsy. In developing countries, where advanced noninvasive methods for the assessment of liver damage are unaffordable or unavailable, this interrupted, short-term regimen may present an acceptable and safe method of using MTX in carefully selected patients with severe psoriasis.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Short‐term methotrexate therapy in psoriasis: a study of 197 patients

2002

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“…Routine monitoring of liver function tests does not reflect the slow progressive underlying fibrosis with minimal inflammation due to MTX. On the other hand, several studies have shown that histological examination of liver biopsies is the most accurate available means of monitoring MTX-induced hepatotoxicity and minimizing the risk of cirrhosis (4,(18)(19)(20)(21)(22). Nevertheless controversy exists on the justification for liver biopsies before treatment with MTX.…”

Section: Discussionmentioning

confidence: 99%

“…M ethotrexate (MTX) is widely used in the treatment of severe forms of psoriasis and psoriatic arthritis. A number of studies have documented its efficacy and the high degree of patient compliance (1)(2)(3)(4)(5).…”

mentioning

confidence: 99%

Methotrexate Hepatotoxicity in Psoriatics: Report of 104 Patients from Nova Scotia, with Analysis of Risks from Obesity, Diabetes and Alcohol Consumption During Long Term Follow‐Up

Malatjalian

Ross

et al. 1996

Canadian Journal of Gastroenterology and Hepatology

130

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In this first Canadian study evaluating MTX hepatotoxicity in psoriatics, the incidence of severe hepatotoxicity is high: 23.1% (24 of 104 patients). This study shows that diabetic patients are particularly at increased risk of MTX hepatotoxicity. Occasional alcohol consumption is not associated with increased risk. Three patients who developed cirrhosis over two years of standard MTX therapy may represent a subset of psoriatics with increased hepatic susceptibility to MTX. Another three patients whose severe hepatic fibrosis had regressed upon discontinuation of MTX, but who developed accelerated recurrence of the severe hepatic fibrosis upon resumption of MTX therapy, also suggest the possibility of unusual sensitivity to the drug. These cases emphasize the need for continuing surveillance, with regular liver biopsies, of psoriatic patients on MTX.

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“…Methotrexate (MTX) has been used for the treatment of severe psoriasis for more than 20 years (1)(2)(3). In children, the drug is administered safely in many diseases, such as leukemias, lymphomas, histiocytosis X, and a few other malignancies (4).…”

mentioning

confidence: 99%

Methotrexate in Childhood Psoriasis

Kumar

Dhar

Handa

et al. 1994

Pediatric Dermatology

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We treated childhood psoriasis with methotrexate (MTX) in seven children (4 boys, 3 girls) over 7.5 years. Their ages and duration of disease varied from 3.5 to 16 years (mean 12.14 yrs) and 4.8 months to 5 years (mean 2.2 yrs), respectively. Psoriatic erythroderma was seen in three patients, generalized pustular psoriasis in two, recalcitrant psoriasis and psoriatic arthropathy in one each. Pre-MTX liver biopsy performed in 4 children showed grade I changes. Methotrexate was given in a single weekly oral dose of 3.75 to 25 mg (mean 16.6 mg). The duration of treatment necessary to control the disease varied from 6 to 10 weeks (mean 7.9 wks). Total duration of MTX therapy was 31.2 to 46.4 weeks (mean 38.8 wks). Posttherapy disease-free interval ranged between 14.4 and 16.8 weeks (mean 15.5 wks). Follow-up after withdrawal of MTX was 16 to 28 weeks (mean 22.3 wks). Total cumulative MTX dose ranged from 390 to 960 mg (mean 683.6 mg). Side effects were nausea and vomiting in three patients.

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Commentary: three decades of folic acid antagonists in dermatology

Cited by 8 publications

References 0 publications

Short‐term methotrexate therapy in psoriasis: a study of 197 patients

Short‐term methotrexate therapy in psoriasis: a study of 197 patients

Methotrexate Hepatotoxicity in Psoriatics: Report of 104 Patients from Nova Scotia, with Analysis of Risks from Obesity, Diabetes and Alcohol Consumption During Long Term Follow‐Up

Methotrexate in Childhood Psoriasis

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