European S3‐Guidelines on the systemic treatment of psoriasis vulgaris

Pathirana, Delano; Ormerod, AD; Saïag, P.; Smith, Catherine; Spuls, PI; Nast, Alexander; Barker, Jonathan; Bos, J. D.; Gr, Burgio; Chimenti, Sergio; Dubertret, Louis; Eberlein, Bernadette; Erdmann, R.; Ferguson, John L.; Girolomoni, Giampiero; Gisondi, Paolo; Giunta, Alessandro; Griffiths, C.E.M.; Hönigsmann, Herbert; Hussain, M. H.; Jobling, Ray; Karvonen, Seija-Liisa; Kemény, Lajos; Kopp, I.; Leonardi, Craig L.; Maccarone, Mara; Menter, Alan; Mrowietz, Ulrich; Naldi, Luigi; Nijsten, Tamar; Jp, Ortonne; Orzechowski, HD; Rantanen, Tapio; Reich, Kristian; Reytan, Natalie; Richards, Helen L.; Thio, H. Bing; Kerkhof, Peter van de; Rzany, Berthold

doi:10.1111/j.1468-3083.2009.03389.x

Cited by 617 publications

(1,009 citation statements)

References 244 publications

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“…It is characterized by periods of spontaneous regression of variable length. Topical and systemic therapies are recommended, according to international clinical guidelines [4,5]. Maintenance therapy is often the rule, in order to avoid relapse.…”

Section: Discussionmentioning

confidence: 99%

Palmar and plantar psoriasis and homeopathy – Case reports

Nwabudike¹

2017

Our Dermatol Online

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Section: Discussionmentioning

confidence: 99%

Palmar and plantar psoriasis and homeopathy – Case reports

Nwabudike¹

2017

Our Dermatol Online

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“…Administration of MTX thus leads to a reduced synthesis of thymidylate and purine, in a decreased production of DNA and RNA. In activated T cells and in keratinocytes, this mechanism is believed to lead to the antiproliferative and immunomodulatory effects of MTX, which are decisive in the treatment of psoriasis (Pathirana 2009). In contrast to subcutaneous application, the bioavailability after oral dosing is difficult to predict, due to variable resorption.…”

Section: Introductionmentioning

confidence: 99%

“…However, a study in rheumatoid arthritis showed that, administration of 5mg folic acid per week successfully reduced the hepatotoxicity without loss of efficacy (Morgan 1994). Thus, administration of 5 mg folic acid 24 hours after application of MTX is recommended (Pathirana 2009). …”

Section: Introductionmentioning

confidence: 99%

“…The "European S3-Guidelines on the systemic treatment of psoriasis vulgaris" (Pathirana 2009) In one study with 88 patients, the efficacy and safety of methotrexate was compared to cyclosporine (Heydendael 2003). Initially, 15 mg methotrexate divided into three portions administered after an interval of 12-hour each was given orally per week according to the schedule of Weinstein and Frost (Weinstein 1971).…”

Section: Introductionmentioning

confidence: 99%

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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

Warren

Mrowietz

Kiedrowski³

et al. 2017

The Lancet

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Background: We report the study of an intensified dosing schedule of subcutaneous methotrexate (MTX) in patients with moderate-tosevere psoriasis. Methods: In this prospective, double-blind, multicentre phase 3 study (METOP) eligible patients were 18 years or older with a diagnosis of chronic plaque psoriasis at least 6 months before baseline, had a psoriasis area and severity index (PASI) of 10 or more or 10% or greater body-surface area involvement or a dermatology life quality index (DLQI) of 10 or more and were naïve to treatment with MTX. Participants were randomly assigned 3:1 by computer-generated random sequence integrated in the electronic data capture system to receive either MTX at a starting dose of 17.5 mg/week or placebo for the first 16 weeks, followed by openlabel MTX treatment of all patients up to 52 weeks (MTX/MTX and PLC/MTX groups, respectively). Dose escalation to 22.5 mg/week was allowed after 8 weeks of MTX therapy if patients failed to achieve an at least 50% improvement of their baseline PASI (PASI50); blinding was maintained by a corresponding volume increase of placebo injections. Treatment was combined with folic acid 5 mg/week. The primary efficacy endpoint was the proportion of patients achieving a PASI75 response at week 16 analysed by intention to treat with non-responder imputation. This study is registered with the European Medicines Agency, EudraCT number 2012-002716-10. Findings: Between February 2013 and May 2015 120 patients were randomly assigned to receive subcutaneous MTX (n=91) or placebo (n=29). The primary endpoint was met; the PASI75 response rate at week 16 was 41% (n=37) in the MTX group compared to 10% (n=3) in the placebo group [p=0.0026; effect size 30.3% (95% CI 15.3-45.3) MTX vs placebo]. Subcutaneous MTX was generally well tolerated; no cases of serious infections, malignancies, major adverse cardiovascular events or deaths were noted. Serious adverse events were observed in 3 patients started on MTX during the 52-week study period. Interpretation: The study documents a favourable 52-week benefit-risk profile of subcutaneous MTX in psoriasis. The route of administration and the intensified dosing schedule should be considered when using MTX in patients with psoriasis. Role of the funding source (see also below)The study was an investigator-initiated trial supported by a grant from Medac to K.R. Manuscript 2 SummaryBackground: We report the study of an intensified dosing schedule of subcutaneous methotrexate (MTX) in patients with moderate-to-severe psoriasis.

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“…Conventional treatments for psoriasis include topical corticosteroids, topical retinoids, vitamin D analogs, dithranol, tars, salicylic acid, phototherapy, methotrexate, acitretin and cyclosporine A. Non-compliance to therapy is however often encountered because of the messiness associated with applying topical treatments, the limited efficacy of all agents and the high rate of adverse events. Under those circumstances, the identification of new therapies for psoriasis was of utmost importance [11].…”

Section: Introductionmentioning

confidence: 99%

Biological therapies in psoriasis - revisited

Sârbu

Georgescu

Tampa

et al. 2018

Romanian Journal of Internal Medicine

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Psoriasis is a chronic, immune mediated disorder affecting approximately 2% of the population. Even in our days, patients with psoriasis are confronted with stigmatization and social rejection. As a result, their quality of life is significantly impaired. Biological therapies have revolutionized the treatment of moderate to severe psoriasis. The aim of this paper is to look over the most important biological therapies available for the management of plaque-type psoriasis.

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European S3‐Guidelines on the systemic treatment of psoriasis vulgaris

Cited by 617 publications

References 244 publications

Palmar and plantar psoriasis and homeopathy – Case reports

Palmar and plantar psoriasis and homeopathy – Case reports

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

Biological therapies in psoriasis - revisited

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