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

Yan, Kexiang; Zhang, Yuanjing; Han, Ling; Huang, Qiong; Zhang, Zhenghua; Fang, Xu; Zheng, Zhizhong; Yawalkar, Nikhil; Chang, Yuling; Zhang, Qun; Jin, Ling; Qian, Danfeng; Li, Xueying; Wu, Mingshun; Xu, Qiaohu; Zhang, Xuejun; Xu, Jinhua (2019). Safety and Efficacy of Methotrexate for Chinese Adults With Psoriasis With and Without Psoriatic Arthritis. JAMA dermatology, 155(3), pp. 327-334. American Medical Association 10.1001/jamadermatol.2018.5194

Text jamadermatology_yan_2019_oi_180079.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (130kB) | Request a copy

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. Methotrexate-induced 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.

Interest & Impact

Downloads

1 since deposited on 30 Dec 2019
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item