Safety and Efficacy of Methotrexate for Chinese Adults With Psoriasis With and Without Psoriatic Arthritis

Abstract

IMPORTANCE It is necessary to determine whether psoriasis responds to methotrexate in the same manner in patients with and without psoriatic arthritis. OBJECTIVE To evaluate the effectiveness and safety of methotrexate in treating patients with psoriasis with and without psoriatic arthritis. DESIGN, SETTING, AND PARTICIPANTS In this prospective, single-arm, interventional study, a total of 235 patients with psoriasis, 107 without psoriatic arthritis and 128 with psoriatic arthritis who were receiving methotrexate therapy from April 1, 2015, to December 31, 2017, were recruited from the outpatient department of a hospital at a large Chinese university. There were no significant demographic or clinical differences between the subgroups with the exception of diabetes. INTERVENTIONS A 12-week course of low-dosage oral methotrexate (7.5-15 mg weekly). MAIN OUTCOMES AND MEASURES Changes in disease severity, adverse events, blood cell counts, and liver and renal function. RESULTS A total of 235 patients with psoriasis (166 male [66.0%]; mean [SD] age, 49.6 [15.1] years) received methotrexate treatment for 12 weeks. The 90% reduction from baseline Psoriasis Area Severity Index response was significantly lower in patients with psoriatic arthritis than in patients without psoriatic arthritis at week 8 (4 0f 128 [3.1%] vs 12 of 107 [11.2%]; P = .02) and week 12 (19 of 128 [14.8%] vs 27 of 107 [25.2%]; P = .049). Furthermore, the incidence of adverse events, including dizziness (12 of 128 [9.4%] vs 1 of 107 [0.9%]; P = .007), gastrointestinal symptoms (32 of 128 [25.0%] vs 13 of 107 [12.1%]; P = .01), and hepatoxicity (34 of 128 [26.6%] vs 16 of 107 [15.0%]; P = .04), was significantly higher in patients with psoriatic arthritis than in patients without psoriatic arthritis. Methotrexateinduced elevation of alanine aminotransferase levels was associated with body mass index (mean [SD] body mass index, 26 [4] in patients with [P = .04] vs 26 [4] in those without [P = .005] psoriatic arthritis) and smoking (17 of 34 [50.0%] in patients with [P = .02] vs 9 of 16 [56.3%] in those without [P = .04] psoriatic arthritis). CONCLUSIONS AND RELEVANCE In this study, methotrexate was well tolerated and effective in treating psoriasis. It was more effective, with fewer adverse effects, in patients with psoriasis who did not have psoriatic arthritis than in patients who presented with both psoriasis and psoriatic arthritis. Therefore, methotrexate can be recommended as first-line treatment for psoriasis without arthritis.

Involvement of Gut Microbiota in the Development of Psoriasis Vulgaris

“…After exclusion of incomplete questionnaires, 326 (response rate 71%) were qualified for further analysis, including 159 patients with psoriasis (108 males and 51 females) and 167 non-psoriatic controls (84 males and 83 females). The two groups were age-matched, and the differences in sex ratio ( 27 ) and BMI ( 28 ) were consistent with previous epidemiological findings. The summary of demographic and clinical details was described in Table 1 .…”

Short-term tolerability and effectiveness of methotrexate monotherapy in adult patients with Crohn’s disease: a retrospective study

“…The previously reported incidence of leukopenia during MTX treatment ranged from 1% to 7%. 12,18,27,[29][30][31] Leukopenia occurred in 11.8% of our study population; of 10 patients with leukopenia, 7 (8.2%) had grade 1 leukopenia with little clinical significance; the other 3 (3.5%) patients who had grade 2 leukopenia can be considered clinically significant.…”

Dihydroartemisinin ameliorates psoriatic skin inflammation and its relapse by diminishing CD8+ T-cell memory in wild-type and humanized mice

“…Psoriasis is an immune-mediated chronic skin disease, which is prone to relapse and affects approximately 2% of the population worldwide 1 . Although the pathogenesis of psoriasis remains unclear, it has been widely recognized that T cells, especially CD4 + Th17 and IL-17-producing γδ T cells, play an important role in the development and progression of psoriasis 2 , 3 and cutaneous DTH responses 4 .…”