Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial

Radmanesh, Mohammad; Rafiei, Behnam; Moosavi, Zahra-Beigum; Sina, N

doi:10.1111/j.1365-4632.2011.04967.x

Cited by 28 publications

(16 citation statements)

References 5 publications

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“…The included studies randomized 1,352 patients, of whom 1,206 were included in the final analysis. The loss to follow-up was mainly attributable to one study, in which 305 patients were randomized but only 202 patients were analysed (12).…”

Section: Rct Search Results and Study Characteristicsmentioning

confidence: 99%

Methotrexate Dosing Regimen for Plaque-type Psoriasis: A Systematic Review of the Use of Test-dose, Start-dose, Dosing Scheme, Dose Adjustments, Maximum Dose and Folic Acid Supplementation

Menting¹,

Dekker²,

Limpens³

et al. 2016

Acta Derm Venerol

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There is a range of methotrexate dosing regimens for psoriasis. This review summarizes the evidence for test-dose, start-dose, dosing scheme, dose adjustments, maximum dose and use of folic acid. A literature search for randomized controlled trials and guidelines was performed. Twenty-three randomized controlled trials (29 treatment groups) and 10 guidelines were included. Two treatment groups used a test-dose, 5 guidelines recommend it. The methotrexate start-dose in randomized controlled trials varied from 5 to 25 mg/week, most commonly being either 7.5 mg or 15 mg. Guidelines vary from 5 to 15 mg/week. Methotrexate was administered as a single dose or in a Weinstein schedule in 15 and 11 treatment-groups, respectively; both recommended equally in guidelines. A fixed dose (n = 18), predefined dose (n = 3), or dose adjusted on clinical improvement (n = 8) was used, the last also being recommended in guidelines. Ten treatment groups used folic acid; in 2 it was allowed, in 14 not mentioned, and in 3 no folic acid was used. Most guidelines recommend the use of folic acid. Authors' suggestions for methotrexate dosing are given.

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Section: Rct Search Results and Study Characteristicsmentioning

confidence: 99%

Methotrexate Dosing Regimen for Plaque-type Psoriasis: A Systematic Review of the Use of Test-dose, Start-dose, Dosing Scheme, Dose Adjustments, Maximum Dose and Folic Acid Supplementation

Menting¹,

Dekker²,

Limpens³

et al. 2016

Acta Derm Venerol

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“…Among them, nephrotoxicity has been regarded as one of the most important side effects. Compared to cyclosporine, the main side effects of methotrexate are irreversible liver cirrhosis, bone marrow suppression, and mucosal damage 13 . In addition, acute side effects such as elevation of liver enzymes are frequently reported during treatment with methotrexate 13 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Compared to cyclosporine, the main side effects of methotrexate are irreversible liver cirrhosis, bone marrow suppression, and mucosal damage 13 . In addition, acute side effects such as elevation of liver enzymes are frequently reported during treatment with methotrexate 13 14 . In this study, abnormalities in AST/ALT were found in two patients (9.5%) while only one patient (4.8%) had an abnormality in uric acid levels.…”

Section: Discussionmentioning

confidence: 99%

The Advantage of Cyclosporine A and Methotrexate Rotational Therapy in Long-Term Systemic Treatment for Chronic Plaque Psoriasis in a Real World Practice

et al. 2017

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BackgroundPsoriasis is a chronic inflammatory disease. In the treatment of psoriasis, cyclosporine is commonly prescribed systemic agents. However, long-term use of cyclosporine is not recommended because of side effects such as nephrotoxicity or hypertension.ObjectiveTo ascertain the improved safety of rotational therapy using cyclosporine and methotrexate, we investigated the frequency of abnormal results in laboratory test after long term rotational therapy using cyclosporine and methotrexate.MethodsFrom January 2009 to June 2014, patients who were treated with cyclosporine or methotrexate were enrolled. The clinical data and usage of medications were reviewed. Laboratory tests were conducted before starting the treatment and regularly follow-up. The occurrences of any laboratory abnormalities during the treatments were investigated.ResultsA total of 21 psoriatic patients were enrolled. The mean of medication period and cumulative dose of cyclosporine and methotrexate were 497.81±512.06 days and 115.68±184.34 g in cyclosporine and 264.19±264.71 days and 448.71±448.63 mg in methotrexate. Laboratory abnormalities were found in total two patients after rotational therapy: two patients (9.5%) in aspartate aminotransferase/alanine aminotransferase and one patient (4.8%) in uric acid. No laboratory abnormalities were found in renal function test.ConclusionWe found that the rotational approaches using cyclosporine and methotrexate reduced the possibility of the development of nephrotoxicity. In addition to other advantage such as quick switching from one agent to another, the rotational therapy using cyclosporine and methotrexate can minimize the adverse events during the systemic treatment of chronic plaque psoriasis.

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“…Methotrexate (MTX) is one of the most clinically effective therapies used in the treatment of psoriasis . Clinical data from trials suggest that patients achieved 50–60% improvement in mean PASI at week 16–24 at a dosage of 15–19 mg weekly . However, patients may become resistant to MTX over time and increase in dosage can have serious side effects.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of platelet rich plasma in combination with methotrexate in chronic plaque psoriatic patients

Chakravdhanula¹,

Anbarasu²,

Verma³

et al. 2016

Dermatologic Therapy

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Psoriasis affects up to 3% of the world's population or more than 125 million people. There is an urgent need for new treatment strategy, as up to 50% of patients are not satisfied with current therapies. We evaluated the combined efficiency of platelet rich plasma (PRP) and methotrexate (MTX) in the management of patients with plaque psoriasis. Twenty-one patients with chronic plaque psoriasis were recruited in the study. Sixteen patients were assigned into combinational treatment group (PRP + MTX) and monotherapy group (MTX alone) consisted of five patients. All patients in combinational therapy received autologous PRP in their first sitting and subsequently followed with folitrax-15 for 4 weeks, while patients in monotherapy group received only folitrax-15, all patients received intra-lesional injections. Digital photograph, Psoriasis Area Severity Index (PASI) score and adverse events were recorded at weeks 0, 4, 8, 12 and 16 and were evaluated by three investigators independently. Patients treated with PRP/MTX showed substantial improvement in term of reduction in erythema, induration and desquamation at each visit and was effectively cleared off psoriasis at week 16. Combination treatment of PRP with MTX was well tolerated by all patients without any serious adverse events.

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Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial

Abstract: Nausea, vomiting, headache, and fatigue were significantly less common side effects in our patients who received MTX daily, but liver enzyme abnormalities were less common, and clinical efficacy was greater in the patients who received MTX weekly.

Cited by 28 publications

References 5 publications

Methotrexate Dosing Regimen for Plaque-type Psoriasis: A Systematic Review of the Use of Test-dose, Start-dose, Dosing Scheme, Dose Adjustments, Maximum Dose and Folic Acid Supplementation

Methotrexate Dosing Regimen for Plaque-type Psoriasis: A Systematic Review of the Use of Test-dose, Start-dose, Dosing Scheme, Dose Adjustments, Maximum Dose and Folic Acid Supplementation

The Advantage of Cyclosporine A and Methotrexate Rotational Therapy in Long-Term Systemic Treatment for Chronic Plaque Psoriasis in a Real World Practice

Clinical efficacy of platelet rich plasma in combination with methotrexate in chronic plaque psoriatic patients

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