Methotrexate revisited: effects of long-term treatment in psoriasis

Abstract

In the past 22 years, 113 patients with severe psoriasis have been treated with low-dose methotrexate (MTX) in our department. The maximum weekly dosage was 15 mg (Weinstein schedule), the estimated mean cumulative dose was 4803 mg, and the estimated mean duration of therapy was 8 years and 11 months. In 81% of the patients, prolonged clearance or near clearance was achieved, indicating the potent and sustained potential of MTX in the treatment of both the pustular and erythematosquamous variants of psoriasis. Eighty-three patients (73%) had side-effects, most frequently abnormal liver function tests, nausea and gastric complaints. Apart from hair loss in seven patients, there were no mucocutaneous side-effects, probably because of the low-dose treatment schedule. In 71 patients MTX therapy was discontinued; in 33 patients because of side-effects. In 55 patients one or more liver biopsies were performed. Fibrosis was seen in seven of these patients (13%) and cirrhosis in two (4%). There was no relation between liver biopsy classification and cumulative dosage or duration of MTX therapy, nor was there any relation between liver histology and abnormal liver function tests. During this 22-year period, there were no deaths or life-threatening side-effects attributable to MTX treatment. We conclude that low-dose MTX (< or = 15 mg/week) is a relatively safe therapy for severe psoriasis, if patients are carefully selected beforehand, and regular monitoring for side-effects and drug interactions is performed during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary Adenosine and Aminoimidazolecarboxamide Excretion in Methotrexate-Treated Patients With Psoriasis

“…Low-dose methotrexate therapy has been a mainstay in the treatment of psoriasis for several decades. [3][4][5][6][7][8] Methotrexate in high doses is used successfully in chemotherapy. The relatively low doses used to treat autoimmune disease do not provide the cell kill necessary for cancer therapy; therefore, the mechanisms of action of methotrexate in these 2 diseases are likely to be different.…”

Study of magnetic silk fibroin nanoparticles for massage-like transdermal drug delivery

“…[34][35][36] The systemic use of this drug causes numerous side effects, such as hepatic toxicity, thrombocytopenia, anemia, fatigue, and so on. 37 Topical delivery of MTX would be preferable and beneficial to reduce its side effects. However, a disappointing result has been reported on the insufficient percutaneous absorption of MTX.…”

Tempting Liver Fibrosis? Long-Term Psoriatic Methotrexate Therapy and Heterozygous α₁-Antitrypsin Deficiency

“…By contrast, there are other studies which suggest that this risk of liver fibrosis is overstated [3, 13, 14]. Indeed, long-term low-dose methotrexate therapy is said to be relatively free of this risk [15, 16], provided that other profibrogenic agents or diseases have been excluded.…”