Methotrexate: Remission, Relapse and Safety In Psoriasis Patients
Methotrexate in psoriasis: Efficacy and Safety
Keywords:
Methotrexate, Psoriasis, Remission, Relapse, Side effectsAbstract
Background: Methotrexate, in low dose, has been widely used therapy in psoriasis patients. It has a good safety profile if used with proper monitoring. It helps to achieve quick remission and delays relapse. This study was done to evaluate safety and efficacy of methotrexate in terms of adverse drug reaction as well as relapse and remission. This was an observational prospective study performed in dermatology department of a tertiary care government hospital. Methodology: : Total 43 patients with psoriasis were given methotrexate and were evaluated for remission, relapse and adverse drug reactions. Statistical analysis used: MedCalc stastical software was used to evaluate the data. Results: Out of 43 patients, 42 patients achieved remission within 2-24 weeks. (Median - 4 weeks) 28 patients out of 33 showed relapse within the span of 2-24 weeks; while five patients did not show the signs of relapse till six months after stoppage of MTX. Minor adverse reactions were seen in 21% of patients amongst which, only two cases with hepatitis needed withdrawal of methotrexate. Conclusion : Methotrexate is still a near to gold standard therapy for psoriasis. It induces quick remission and delays relapse significantly. Methotrexate, if given with proper monitoring, will have significantly low risk of adverse effects. [Thakkar S NJIRM 2015; 6(2):15-19]
References
2. Lomholt G. Prevalence of skin disease in a population, a census study from the Faroe Islands. Danmed Bull. 1964;11:1-7.
3. Zachariae H. MTX side effects. Br J Dermatol 1990; 122:127-133.
4. Weinstein GD, Frost P. MTX for psoriasis: a new therapeutic schedule. Arch Dermatol. 1971;103:33-38.
5. Warren RB, Chalmers RJG, Griffiths CEM, Menter A. MTX for psoriasis in the era of biological therapy. Clin Exp Drematol 2008;33:551-4.
6. Cronstein BN, Naime D, Osted E. The anti-inflammatory effects of MTX are mediated by adenosine. Adv Exp Med. 1994;370:411-6.
7. Warren RB, Griffiths C.E.M. Systemic therapies for psoriasis: MTX, retinoids, and cyclosporine. Clin Dermatol. 2008;26:438-47.
8. Genestier L, Paillot R, Fournel S, Ferraro C, Miossec P, Revillard JP. Immunosuppressive properties of MTX: apoptosis and clonal deletion of activated peripheral Tcells. J Clin Invest. 1998;102:322-8.
9. Johnston A, Gudjonsson JE, Sigmundsdottir H, Ludviksson BR, Valdimarsson H. The anti-inflammatory action of MTX is not mediated by lymphocyte apoptosis, but by the suppression of activation and adhesion molecules. Clin Immunol. 2005;114:154-63.
10. Torres-Alvarez B, Castanedo-Cazares JP, Fuentes-Ahumada C, Moncada B. The effect of MTX on the expression of cell adhesion molecules and activation molecules CD69 in psoriasis in psoriasis. J Eur Acad Dermatol Venereol. 2007;21:334-9.
11. Walsdorfer U, Christophers E, Schroder J-M. MTX inhibits polymorphonuclear leukocytechemotaxis in psoriasis. Br J Dermatol 1983;108:451-6.
12. Roenigk HH, Auerbach R, Maibach HI et al MTX in psoriasis: revised guidelines. J Am Acad Dermatol 1988;19:145-6.
13. Jih DM, Werth VP. Thrombocytopenia after a single test dose of MTX. J Am Acad Dermatol 1988;39:349=51.
14. CEM Griffiths, RDR Camp & JNWN Barker. Psoriasis in Rook’s textbook of dermatology-7th edition 2004. Edited by Tony Burns, Stephen Breathnach, Neil Cox, Christopher Griffiths.
15. Karibasappa NA, George A. Relapse in psoriasis after methotrexate. Indian J Dermatol Venereol Leprol 1997;63:307-9.
16. Dhir R, Tutakne MA, Chari K. Relapse in psoriasis after MTX. Indian J Dermatol Venereol Leprol 1992;58:77-9.
17. G. Carretero, L. Puig, L. Dehesa, JM Carrascosa, M. Ribera, M. Sanchez-Regana et al. Guidelines on the use of Methotrexate in Psoriasis. Actas Dermosifiliogr.2010;101(7):600-613.
18. Masuria BL, Mittal A, Gupta LK, Sharma M, Bansal N. Methotrexate : Side effects and the role of folic acid supplementation in psoriasis - A study. Indian J Dermatol Venereol Leprol 1997;63:219-22.
19. Duhra P, Hodgson C, IIchyshyn A, et al. Prevention of adverse reactions associated with methotrexate therapy for psoriasis (abstract), Br J Dermatol 1991;125(Suppl.39):26.
