Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a prospective, randomized study

Janagond, Ajit B; Kanwar, Amrinder J.; Handa, Sanjeev

doi:10.1111/jdv.12004

Cited by 45 publications

(28 citation statements)

References 15 publications

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“…Alitretinoin is usually well-tolerated but sometimes headaches or flushing is problematic. Acitretin is another retinoid which is approved for the treatment of plaque psoriasis and is very effective for palmoplantar psoriasis (6). A previous open-label study suggested that acitretin could improve mild-to-moderate CHD (7).…”

Section: Introductionmentioning

confidence: 99%

Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis

Tan

Maari

Nigen

et al. 2014

Journal of Dermatological Treatment

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Section: Introductionmentioning

confidence: 99%

Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis

Tan

Maari

Nigen

et al. 2014

Journal of Dermatological Treatment

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“…Notably, in this study, acitretin effectiveness could be negatively affected by the palmoplantar localization that was observed in about half of patient population. Indeed, a recent head‐to‐head study published in 2013 on a small cohort of patients, showed a reduced acitretin efficacy vs. methotrexate in treating plaque psoriasis with palmoplantar localization (Janagond, Kanwar, & Handa, ).…”

Section: Discussionmentioning

confidence: 99%

Optimizing acitretin use in patients with plaque psoriasis

Chiricozzi

Panduri

Dini

et al. 2016

Dermatologic Therapy

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Acitretin is one of the systemic agents used for the treatment of psoriasis. Because different acitretin dosages resulted therapeutically successful, there is no general agreement on the optimal dose regimen. To report acitretin efficacy and safety in a real-life setting, wherein patient-tailored dose regimen is usually prescribed, a retrospective analysis evaluating charts of all plaque-type psoriasis patients treated with acitretin from the clinic database was performed. PASI score improvement, as well as PASI 50, 75, 90, and 100 responses were assessed throughout the observational period. Overall, 52% PASI score reduction and a satisfactory safety profile were detected. PASI 50, 75, 90, and 100 response was achieved by 53%, 48%, 28%, and 14%, respectively. Treatment consisted on a mean daily acitretin dose of 25.01 mg. The initial dose was increased (51.2% of cases) or decreased (48.8%) prescribing a mean daily dose of 29.8 mg and 20.02 mg, respectively. This study proposed a dose regimen customized on clinical response and patient's needs, to optimized acitretin benefit.

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“…It has limited response to standard agents as MTX, cyclosporine and acitretin [15]. The observed effect of NS in this type of psoriasis may indicate that the ointment has the ability to penetrate the thick epidermis of the palms and soles and exerts its effect in these sites.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of Nigella sativa, methotrexate and their combination in the treatment of moderate to severe psoriasis

Ahmed

Kadhim²,

Al-Hamdi³

2014

J Clin Exp Invest

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Objective: Methotrexate (MTX) is a commonly prescribed drug for patients with psoriasis. Nigella sativa (NS) has been shown beneficial in vitiligo and in eczema. Recently, NS has shown activity in modifying psoriatic lesions. The aim of this study was to evaluate the effect of the combination (NS+MTX) on psoriasis and to compare that with NS or MTX monotherapy. Methods:Sixty patients with moderate to severe plaque, palmoplantar and guttate psoriasis were enrolled for 12 weeks study. The patients were divided into 3 groups; 20 patients in each. Group 1 was treated with NS ointment (20% w/w) 2 times daily + 500 mg NS capsule 3 times daily. Group 2 received MTX tablets 15 mg weekly and group 3 received MTX + NS (topical + oral). Results:Marked response was achieved in 60%, 80%, and 90% of patients on NS, MTX, and (NS + MTX) respectively. The respective relapse rate was 33.3%, 56.3%, and 27.8%. Serum malondialdehyde (sMDA), a parameter of oxidative stress was decreased from 4.39 ± 0.81 to 2.31 ± 0.72 µmol/L with NS treatment while a small increase in sMDA was observed with MTX. NS + MTX treatment reduced sMDA from 4.39 ± 0.67 to 3.49 ± 0.65 µmol/L after 12 weeks treatment. All treatments did not change liver enzymes or complete blood count. NS was well tolerated and showed ability in ameliorating gastric upset of MTX. Yöntemler: Orta-ağır plak, palmoplantar ve guttat psöri-azisli 60 hasta 12 haftalık çalışmaya alındı. Hastalar her grupta 20'şer hasta olacak şekilde 3 gruba ayrıldı. Grup 1'e günde 2 kez uygulanan NS merhemi (%20'lik)'ne ilaveten günde 3 kez 500 mg NS kapsülleri verildi. Grup 2 haftada bir 15 mg MTX tableti aldı ve Grup 3'e MTX+NS (Topikal ve oral) verildi. Bulgular: NS, MTX ve NS+MTX gruplarında sırasıyla %60, %80 ve %90 cevap alındı. NS tedavisi ile oksidatif stres belirteci olan serum malondialdehid (sMDA) 4,39 ± 0,81 µmol/L'den 2,31 ± 0,72 µmol/L'ye düştü, ancak MTX ile sMDA'da hafif artış gözlendi. 12 haftalık MTX ve NS+MTX tedavilerini takiben sMDA 4.39 ± 0.67 µmol/ L'den 3.49 ± 0.65 µmol/L'ye indi. Tedavilerin tümünde karaciğer enzimleri ve tam kan sayımlarında bir değişiklik gözlenmedi. NS iyi tolere edildi ve MTX'in yaptığı mide rahatsızlığını iyileştirici etkisi gözlendi. Sonuç: NS, MTX'in anti-psöriatik etkisini kuvvetlendirdi. Topikal ve oral NS kullanımı orta ve ağır psöriazisde etkin ve güvenlidir. Conclusion

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Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a prospective, randomized study

Abstract: Methotrexate is relatively inexpensive, safe and efficacious drug for the treatment of psoriasis patients with significant palmoplantar involvement. Acitretin can be used as an alternative therapy and with a good safety profile.

Cited by 45 publications

References 15 publications

Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis

Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis

Optimizing acitretin use in patients with plaque psoriasis

The effectiveness of Nigella sativa, methotrexate and their combination in the treatment of moderate to severe psoriasis

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