Methotrexate for Psoriasis

REES, REES B.

doi:10.1001/archderm.1967.01600310008002

Cited by 114 publications

(11 citation statements)

References 21 publications

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“…In our study, complete clearance was noted in 13/15 (86.6%) patients on MTX. Conversely, in studies by Rees et al (20) and Roenigk et al (19), the response was slower, and complete clearance was noted in only 45–60% of the patients on weekly methotrexate therapy. All the thirteen patients who attained complete clearance remained free of their lesions even after gradual reduction in the dose of methotrexate.…”

Section: Discussionmentioning

confidence: 87%

Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study from North India

Sandhu

Kaur

Kumar

et al. 2003

The Journal of Dermatology

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Treatment of patients with severe psoriasis is difficult. Among the number of systemic drugs that are available, methotrexate has long been used, but cyclosporine has been recently recommended for the management of severe psoriasis. The purpose of this study was to compare the efficacy and safety of daily cyclosporine with weekly methotrexate in the management of severe psoriasis. Thirty consecutive patients with severe psoriasis were randomly assigned to treatment with cyclosporine or methotrexate. The initial dose of cyclosporine was 3 mg/kg/day, which was increased to a maximum of 4 mg/kg after two weeks of therapy when the response was not adequate. Methotrexate was administered weekly at a dose of 0.5 mg/kg. Clinical response was assessed by calculating PASI score in all patients at biweekly intervals. Patients were followed up fortnightly up to a maximum of 12 weeks. The doses of both drugs were gradually tapered once >75% reduction in disease severity was attained. Marked improvement (>75%) reduction in PASI was noted in all patients except for one in the cyclosporine group. The median time for marked improvement was 5.3 weeks with methotrexate and 6.8 weeks with cyclosporine. Patients on methotrexate were found to have more rapid and complete clearance than those on cyclosporine. Both drugs were well tolerated. Side effects in both the treatment groups were minor, transient, and manageable. At doses with comparable safety profiles, methotrexate resulted in more rapid and cost effective clearance of patients with severe psoriasis. Cyclosporine can provide an effective and safe alternative.

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Section: Discussionmentioning

confidence: 87%

Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study from North India

Sandhu

Kaur

Kumar

et al. 2003

The Journal of Dermatology

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“…24 Clinical studies done prior to the mainstream use of the PASI score and using other evaluation models showed that approximately 75% of patients on methotrexate improved by at least 75%. [25][26][27][28][29] Yet when studied prospectively using PASI to assess response, only 26% of patients achieved PASI 75 in an aggressive (doses of up to 30 mg/wk along with folic acid, 1 mg twice a day on days not taking methotrexate, for 6 months), open-label methotrexate trial of 25 patients at the University of Utah. 30 Sixty-three percent of patients on this regimen achieved PASI 50 (Fig 3).…”

Section: Pasi Improvement With a Known Effective Therapymentioning

confidence: 99%

A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis

Carlin

Feldman

Krueger

et al. 2004

Journal of the American Academy of Dermatology

256

181

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“…Usual dosage schedules used in Europe include weekly administration in the range of 10–35 mg orally or intramuscularly. More frequent administration appears to be associated with a higher frequency of hepatic fibrosis 57,59 , 60 …”

Section: Usesmentioning

confidence: 99%

Traditional therapies: glucocorticoids, azathioprine, methotrexate, hydroxyurea

Belgi

Friedmann

2002

Clinical and Experimental Dermatology

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The 'old favourites' used for treatment of inflammatory diseases, and hence, the original immunomodulators, include the glucocorticoids, azathioprine, methotrexate and hydroxyurea. Glucocorticoids are still one of the most effective anti-inflammatory agents because they work on several different intracellular processes and hence, block many components that contribute to inflammatory and immune responses. They bind to intracellular glucocorticoid receptors which transport them into the nucleus. Here the receptor/steroid complex may bind to many genes that interact with transcription factors including NFkappaB and AP-1, to inhibit their activation, thereby preventing activation of many genes encoding immune effector and pro-inflammatory cytokines. Also, protein kinases involved in intracellular signalling, are directly activated resulting in phosphorylation of various targets of which Annexin (AXA)-1 is critical in inhibiting biosynthesis of both purines and DNA. This results in reduced proliferation of B and T lymphocytes, reduced immune effector mechanisms and reduced recruitment of mononuclear cells including monocytes into sites of immune inflammation. Methotrexate also blocks DNA synthesis and hence cellular proliferation but also induces release of adenosine. This inhibits chemotaxis of polymorph neutrophils and release of critical cytokines such as TNF-alpha and Interleukins 6 and 8. Hydroxyurea also inhibits DNA synthesis with inhibitory effects on proliferation of lymphocytes and possibly kerationcytes. Even though many new agents with much greater selectivity are coming through into clinical use, this group of old agents still have an absolutely central position in the therapeutic armamentarium. Their value lies in the fact that they are not 'clean' drugs with narrow effects but they inhibit a wide range of mechanisms involved in immune and inflammatory processes.

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Methotrexate for Psoriasis

Cited by 114 publications

References 21 publications

Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study from North India

Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study from North India

A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis

Traditional therapies: glucocorticoids, azathioprine, methotrexate, hydroxyurea

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