The efficacy of methotrexate plus pioglitazone vs. methotrexate alone in the management of patients with plaque‐type psoriasis: a single‐blinded randomized controlled trial

Lajevardi, Vahideh; Hallaji, Zahra; Daklan, Soroush; Abedini, Robabeh; Goodarzi, Azadeh; Abdolreza, Mona

doi:10.1111/ijd.12585

Cited by 44 publications

(43 citation statements)

References 30 publications

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“…It was observed that troglitazone normalized the histological features of psoriatic skin and reduced the hyperplasia in mouse and human skin models of psoriasis. Pioglitazone is also noted to enhance the effect of methotrexate in plaque psoriasis in a recent study [47]. However, topical administration of these agents has failed to demonstrate any significant response in pilot studies among patients with psoriasis [46].…”

Section: Psoriasismentioning

confidence: 99%

Peroxisome proliferator-activated receptors (PPARs) and PPAR agonists: the ‘future’ in dermatology therapeutics?

Gupta¹,

Mahajan²,

Mehta³

et al. 2015

Arch Dermatol Res

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Peroxisome proliferator-activated receptors (PPARs) are nuclear hormone receptors and comprise three different isoforms namely PPARα, PPARγ, and PPARβ/δ with PPARβ/δ being the predominant subtype in human keratinocytes. After binding with specific ligands, PPARs regulate gene expression, cell growth and differentiation, apoptosis, inflammatory responses, and tumorogenesis. PPARs also modulate a wide variety of skin functions including keratinocyte proliferation, epidermal barrier formation, wound healing, melanocyte proliferation, and sebum production. Recent studies have shown the importance of PPARs in the pathogenesis of many dermatological disorders. Clinical trials have suggested possible role of PPAR agonists in the management of various dermatoses ranging from acne vulgaris, psoriasis, hirsutism, and lipodystrophy to cutaneous malignancies including melanoma. This article is intended to be a primer for dermatologists in their understanding of clinical relevance of PPARs and PPAR agonists in dermatology therapeutics.

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Section: Psoriasismentioning

confidence: 99%

Peroxisome proliferator-activated receptors (PPARs) and PPAR agonists: the ‘future’ in dermatology therapeutics?

Gupta¹,

Mahajan²,

Mehta³

et al. 2015

Arch Dermatol Res

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“…A 2016 meta‐analysis of the efficacy of methotrexate in psoriasis showed that only 11 studies, which included randomized controlled trials (RCT), with a total number of 937 patients, were eligible to meta‐analyse . Most of the studies included in that meta‐analysis investigated the comparative efficacy of methotrexate versus other treatments, and most reported short‐term (12–16 weeks) efficacy of methotrexate . Meta‐analysis revealed that 45.2% of patients receiving methotrexate achieved a 75% reduction in Psoriasis Area and Severity Index (PASI) score during the week 12–16 treatment window .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of and factors associated with clinical response to methotrexate under daily life conditions in Asian patients with psoriasis: A retrospective cohort study

Pongparit

Chularojanamontri

Limphoka

et al. 2018

The Journal of Dermatology

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Given the relative scarcity of data concerning the efficacy of methotrexate under daily life conditions in psoriasis, this study aimed to investigate the effectiveness of methotrexate in Asian psoriatic patients and to identify factors associated with clinical response. This observational retrospective cohort study included adult psoriatic patients who had been treated with or were going to start methotrexate. Psoriasis Area and Severity Index (PASI) scores at baseline and at 3, 6 and 12 months were recorded. At 3 months, patients achieving 50% or more reduction from baseline PASI score were defined as responders. One hundred, 74 and 61 patients were followed for 3, 6 and 12 months, respectively. Mean follow-up time was 15.3 ± 10.2 months. A reduction in PASI score of at least 75% was achieved in 26%, 32.5% and 45.2% at 3, 6 and 12 months, respectively. At 12 and 24 months, Kaplan-Meier analysis showed 68.7% and 52.1% probability of drug survival, respectively. Male sex, body mass index (BMI) of less than 25 kg/m and absence of abdominal obesity were factors associated with response to treatment in univariate analysis. Male sex was the only significant factor in multivariate analysis. The effectiveness of methotrexate in clinical practise seemed to be lower than in clinical trials, but effectiveness increased with longer duration of treatment. Problems associated with methotrexate use in clinical practise may be due to medication adherence rather than lack of medication effectiveness. Female sex, abdominal obesity and BMI of 25 kg/m or more might decrease response to methotrexate.

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“…The incidence of adverse effect was less as compared to a previous study. 21 Our study had two important advantages. It had a longer duration in comparison with previous studies considering the effect of pioglitazone on plaque-type psoriasis.…”

Section: Resultsmentioning

confidence: 99%

A study to compare the efficacy of methotrexate alone vs. methotrexate plus pioglitazone in the management of plaque-type psoriasis

Shabeer

Bhandare

Satyanarayana

et al. 2017

Int J Basic Clin Pharmacol

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INTRODUCTIONPsoriasis is one of the common, chronic, inflammatory cutaneous diseases in India.1 It is characterized by aberrant differentiation and hyperproliferation of keratinocytes and inflammatory infiltration of leukocytes, predominantly into the dermis.2 It affects 2% to 3% of the world's population, with chronic plaque-type psoriasis accounting for approximately 90% of the cases. 2Prevalence of psoriasis ranges across population from 0% to 11.8% across different populations. 3,4 In India, most prevalence studies are hospital based. 5Kaur et al study that included 782 patients showed a prevalence of 1.4 % among the total dermatology outpatients. A similar study by Bedi et al. reported 2.8% prevalence among the dermatology OPD cases. Genetic correlation in terms of family history showed wide differences between studies. Bedi reported positive family history of psoriasis in 14% of their patients, while Kaur et al reported the same in only 2% of their patients and found that first degree relatives were affected in 84% of the cases, while second degree relatives only in 12% cases. 6,7 Currently the treatment options include the use of Methotrexate, which is an established standard; systemic drug approved by USFDA for the treatment of psoriasis. It acts mainly by inhibiting immune cells and is shown to be more potent in decreasing the number of lymphocytes than keratinocytes. 9Other available options are cyclosporine and oral retinoids, all of which are associated with severe toxicity and are usually an expensive ordeal in Indian scenario. There is a need for novel treatment approach with a better ABSTRACT Background: Psoriasis is a common skin condition affecting a huge segment of global population. So far, the treatment has been confined to drugs like methotrexate, cyclosporine and oral retinoids which are highly toxic for long term usage and requires a novel drug that is safer. Methods: Cases of plaque type psoriasis are divided into two arms and treated with methotrexate monotherapy in group A and methotrexate plus pioglitazone combination therapy in group B. The outcome of the study is analyzed using PASI score and DLQI scoring systems. Results: Group A and Group B showed significant reduction in the PASI and DLQI scores. Group B was better in terms of efficacy (p<0.05) when compared to Group A. There was no significant difference between the groups in terms of DLQI scoring. Both groups had similar side effect profile. Conclusions: Pioglitazone which acts by sensitizing the cells to insulin poses no risk of hypoglycemia. It is more specific for the treatment of psoriasis as it targets the keratinocytes. Present study suggests a possible role as an adjuvant in the treatment of psoriasis, and could pave way for low dose methotrexate and thereby reducing the potential side effects.

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The efficacy of methotrexate plus pioglitazone vs. methotrexate alone in the management of patients with plaque‐type psoriasis: a single‐blinded randomized controlled trial

Cited by 44 publications

References 30 publications

Peroxisome proliferator-activated receptors (PPARs) and PPAR agonists: the ‘future’ in dermatology therapeutics?

Peroxisome proliferator-activated receptors (PPARs) and PPAR agonists: the ‘future’ in dermatology therapeutics?

Effectiveness of and factors associated with clinical response to methotrexate under daily life conditions in Asian patients with psoriasis: A retrospective cohort study

A study to compare the efficacy of methotrexate alone vs. methotrexate plus pioglitazone in the management of plaque-type psoriasis

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