Methotrexate vs secukinumab safety in psoriasis patients with metabolic syndrome

Abstract

The safety of methotrexate in psoriasis patients with metabolic syndrome could be argued because of increased risk of liver toxicity. The aim of the study was to investigate the safety of methotrexate compared with secukinumab in psoriasis patients with metabolic syndrome. A controlled, open trial in psoriasis patients with metabolic syndrome, candidate to methotrexate, or secukinumab. Primary end point of the study was investigating any variations in waist circumference, body mass index, blood pressure, fasting glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine levels between baseline and month-6 and 12 of follow-up in the two treatment cohorts. A total of 130 (110 male and 20 female) patients were consecutively assigned in a 1:1 ratio to treatment with methotrexate (n = 64) dosed 15 mg weekly or secukinumab (n = 66) at standard dose. At month-6 and month-12 serum levels of liver enzymes were significantly increased only in patients treated with methotrexate (P < .01). Three times elevation of liver enzymes was reported in 4 of 64 patients receiving methotrexate, causing drug withdrawal. No significant changes in other parameters were observed. Methotrexate could induce a liver enzyme increase whereas secukinumab has a neutral effect.

Anti-Interleukin-17 Therapy of Severe Psoriatic Patients Results in an Improvement of Serum Lipid and Inflammatory Parameters’ Levels, but Has No Effect on Body Composition Parameters

“…In the case of the baseline HDLcholesterol levels, values higher than ours were only found in the UNCOVER studies. The highest baseline LDL-cholesterol values were measured in our study compared to the others [31][32][33][34]. Moreover, 60% of our study population was obese.…”

“…In another study, waist circumference, BMI, blood pressure, fasting glucose, total cholesterol, HDL-and LDL-cholesterol, triglyceride, ALT, AST, and creatinine levels were determined among psoriatic patients with metabolic syndrome who received methotrexate or secukinumab therapy for 12 months. In the secukinumab group, significant changes were not observed in the parameters, and in the methotrexate group, a significant increase was observed in liver enzymes [32]. In a retrospective study, Wang et al examined the effect of secukinumab on 99 psoriatic patients during a 24-week treatment and found that hs-CRP was significantly reduced, while body weight and BMI were significantly increased at week 24 [33].…”

Efektifitas dan keamanan dari terapi kombinasi methotrexate dan secukinumab pada Psoriasis vulgaris berat: tinjauan sistematis

“…Pemberian methotrexate secara bersamaan dapat meningkatkan tingkat respon pengobatan psoriasis berat menurut beberapa studi penelitian. 14 Pasien yang terlibat dalam studi meliputi laki-laki dan wanita yang berusia > 18 tahun yang terjangkit psoriasis sedang hingga berat yang disertai dengan riwayat penyakit sindrom metabolik. Pada studinya, pasien yang memenuhi syarat secara berurutan diberi rasio 1:1 untuk secukinumab (dosis standar) atau methotrexate 15 mg/minggu dengan pemberian subkutan dan suplementasi asam folat 5 mg diberikan 24 jam setelah methotrexate.…”

Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review

“…Several clinical trials have shown the efficacy of MTX for inducing and maintaining remission in patients with inflammatory bowel disease (IBD) ( 2 , 3 ). MTX is also commonly used as the mainstay of long-term immunosuppression therapy in rheumatoid arthritis (RA) ( 4 ), psoriasis (Ps) ( 5 ), and psoriatic arthritis (PsA) ( 6 ). However, due to the drug toxicity, long-term MTX therapy is associated with some side effects, most commonly including the gastrointestinal tract symptoms, such as nausea and diarrhea, liver injury, myelosuppression, and interstitial pneumonitis ( 7 ).…”