Methotrexate

Methotrexate has been widely used to treat severe psoriasis since the 1960s. It was the first potent systemic antipsoriatic agent to be introduced into practice and has continued to play a vital role in the management of severe psoriasis, despite the advent of newer treatments. It has not been subjected to the same rigorous evaluation as some newer agents and a recent systematic review found no RCT in which standard methods of methotrexate administration for psoriasis were compared with placebo or with any alternative treatment modality in patients with chronic plaque psoriasis.78 Evidence from case series supports the place of methotrexate as one of the most powerful drugs in common use for severe psoriasis. Only recently has it been formally compared with another systemic agent. No significant difference in response at 16 weeks was found in 85 patients randomised to receive either methotrexate or ciclosporin, although the latter appeared to act more rapidly (Spuls P, personal communication). Methotrexate is normally well tolerated, although nausea is common and can cause patients to stop therapy. Acute myelosuppression is a more important cause of serious morbidity and mortality than the chronic liver damage for which methotrexate is well recognised.

0 0

Post a comment