Monitoring methotrexate hepatotoxicity in psoriasis

Bishnoi, Priya; Kumari, Rashmi; Thappa, Devinder Mohan

doi:10.4103/0378-6323.84014

Cited by 5 publications

(3 citation statements)

References 18 publications

(22 reference statements)

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“…Many literatures proving its superior efficacy in psoriasis can be cited. [20][21][22][23][24][25][26][27][28][29][30][31][32] In a retrospective study conducted over 26 years on 157 patients suffering from extensive plaque or erythodermic psoriasis, Haustein and Rytter found long term, low-dose methotrexate to be sufficiently effective in 76% patients, moderately effective in 18% patients, and poorly effective in rest 6% patients. 15 Weinstein and Frost demonstrated more than 75% reduction in the PASI score at the end of 12 week's treatment in patients suffering from moderate to severe plaque psoriasis.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of isotretinoin in comparison to methotrexate in the patients suffering from moderate-to-severe plaque psoriasis: A prospective cohort study

2022

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Background: Psoriasis is a common dermatological disorder with both inflammatory and genetic etiology. In India, the incidence of psoriasis is on the verge of rise. Very less data is available on the efficacy of isotretinoin versus methotrexate in patients suffering from plaque psoriasis. Aims and Objective: In this prospective cohort study, we aimed at comparing the efficacy and safety of systemic isotretinoin with systemic methothotrexate in patients suffering from moderate to severe plaque psoriasis in a tertiary care medical college hospital in eastern India. Materials and Methods: It was a prospective cohort study conducted in the dermatology and pharmacology department of Burdwan Medical College between December 1, 2020, and August 31, 2021, on 60 patients suffering from moderate to severe plaque psoriasis. Patients receiving methotrexate and isotretinoin as systemic therapy of psoriasis from the dermatology outpatient department at the time of the study constituted the methotrexate and isotretinoin group, respectively. Each group had 30 patients. Psoriasis area severity index (PASI) score and dermatology life quality index (DLQI) score were utilized for evaluation of improvement in disease severity and quality of life, respectively. Different laboratory parameters and patients reported side effects were noted for evaluation of safety. Results: Fifty-eight patients completed the study (28 patients from methotrexate group and 30 patients from isotretinoin group). Both drugs were effective in managing psoriasis. 100% patients in the methotrexate group and 89.28% patients in the isotretinoin group had reached the threshold for a minimal response (25% reduction from baseline PASI score after 12 weeks of treatment). The mean percentage reduction in PASI score was 70.23±6.78 and 52.78±7.34 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Methotrexate was more effective in improving quality of life. The mean percentage reduction in DLQI score were 60.02±5.04 and 28.49±4.84 in methotrexate and isotretinoin group respectively at the end of 12 weeks therapy. This difference was statistically significant. Isotretinoin group showed fewer patient-reported side effects and lower fluctuation of laboratory parameters. Conclusions: Methotrexate is more efficacious than isotretinoin in disease remission and improving quality of life in patients suffering from mild to moderate plaque psoriasis. Isotretinoin is safer than methotrexate.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of isotretinoin in comparison to methotrexate in the patients suffering from moderate-to-severe plaque psoriasis: A prospective cohort study

2022

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“…Methotrexate should be prescribed with caution in obese patients because of the increased risk of liver toxicity, particularly in the case of long-term treatment and in the presence of other risk factors of liver toxicity such as heavy alcohol consumption, chronic hepatitis B and C, obesity, type 2 diabetes, hepatotoxic drugs, and hyperlipidemia [39][40][41]. Indeed, obesity is frequently associated with NALFD/non-alcoholic steatohepatitis that could predispose patients to liver fibrosis.…”

Section: Methotrexatementioning

confidence: 99%

“…In these settings, it is suggested to start with a lower dosage of 7.5-10 mg/week. Moreover, liver elastography or liver biopsy has been proposed for obese patients at baseline (within 2-6 months of starting treatment) and at cumulative doses of 1.0-1.5 g of methotrexate [41].…”

Section: Methotrexatementioning

confidence: 99%

Managing the Patient with Psoriasis and Metabolic Comorbidities

Bellinato,

Maurelli,

Geat

et al. 2024

Am J Clin Dermatol

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Epidemiological data demonstrate strong associations between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. Some drugs should be prescribed with caution in patients with metabolic comorbidities because of an increased risk of adverse events, while others could have a reduced effectiveness. The aim of this narrative review is to highlight the challenges that healthcare professionals may face regarding the management of psoriasis in patients with metabolic comorbidities. In the first part of the article, the epidemiological association between psoriasis and metabolic comorbidities and their pathogenetic mechanisms is summarized. The second part describes the efficacy and safety profile of conventional and biologic drugs in patients with selected metabolic comorbidities including obesity, non-alcoholic fatty liver disease/hepatic steatosis, and diabetes. Finally, the role of pharmacological and non-pharmacological interventions, such as diet, alcohol abstinence, physical activity, and smoking avoidance is discussed. In conclusion, the choice of the best approach to manage patients with psoriasis with metabolic comorbidities should encompass both tailored pharmacological and individualized non-pharmacological interventions.

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