Efficacy of Methotrexate and Methotrexate with Apremilast in Patients with Chronic Plaque Psoriasis

. Aroosa; Sahibzada Mehmood  Noor; Mohammad Majid  Paracha; Qaiser  Hayat; . Hidayatullah; Sana  Hassan

doi:10.54112/bcsrj.v6i6.2002

Authors

. Aroosa Department of Dermatology, Lady Reading Hospital, Peshawar, Pakistan
Sahibzada Mehmood Noor Department of Dermatology, Lady Reading Hospital, Peshawar, Pakistan
Mohammad Majid Paracha Department of Dermatology, Lady Reading Hospital, Peshawar, Pakistan
Qaiser Hayat Department of Dermatology, Agha Khan University Hospital Karachi
. Hidayatullah Department of Dermatology, CMH Hospital Peshawar
Sana Hassan Department of Dermatology, CMH Hospital Peshawar

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2002

Keywords:

Chronic plaque psoriasis, methotrexate, apremilast, PASI score

Abstract

Chronic plaque psoriasis is a prevalent, immune-mediated dermatological disorder characterized by hyperproliferation and inflammation of the skin, leading to significant physical and psychological burden. Although methotrexate remains a cornerstone in systemic therapy for moderate to severe psoriasis, its efficacy may be limited in certain patients. The addition of apremilast, a phosphodiesterase-4 inhibitor, has emerged as a potential combination therapy to enhance treatment outcomes and minimize adverse effects. Objective: To determine the efficacy of methotrexate and methotrexate with apremilast in patients with chronic plaque psoriasis. Methodology: This study was carried out on 68 participants, presenting with chronic plaque psoriasis, which was diagnosed clinically and via histopathological assessment, divided equally into two groups. Group A received methotrexate (10 mg weekly) while Group B received methotrexate with apremilast after 12 weeks treatment. Mean reduction in PASI scores from the baseline after 12 weeks were recorded. Results: The results demonstrated a substantial reduction in PASI scores in Group B (methotrexate + apremilast) showing a greater mean reduction (10.64 ± 3.79) compared to Group A (13.72 ± 5.09) indicating enhanced efficacy with combination therapy (p < 0.05). Conclusion: The combination of methotrexate and apremilast was more effective than methotrexate alone in chronic plaque psoriasis in terms of mean reduction in PASI scores from the baseline.

Downloads

Download data is not yet available.

References

Bowcock AM. The genetics of psoriasis and autoimmunity. Annu Rev Genom Hum Genet. 2005;6(1):93–122. https://doi.org/10.1146/annurev.genom.6.080604.162324

Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370(9583):263–271. https://doi.org/10.1016/S0140-6736(07)61128-3

Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010;34(3):314–321. https://doi.org/10.1016/j.jaut.2009.12.014

Kaushik SB, Lebwohl MG. Psoriasis: which therapy for which patient: focus on special populations and chronic infections. J Am Acad Dermatol. 2019;80(1):43–53. https://doi.org/10.1016/j.jaad.2018.06.057

Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev. 2022;5(5):CD011535. https://doi.org/10.1002/14651858.CD011535.pub4

Mohd Affandi A, Khan I, Ngah Saaya N. Epidemiology and clinical features of adult patients with psoriasis in Malaysia: 10-year review from the Malaysian Psoriasis Registry. Dermatol Res Pract. 2018;2018:4371471. https://doi.org/10.1155/2018/4371471

Romiti R, Fabrício LHZ, Souza CDS, Galvão LO, de Castro CCS, Terena AC, et al. Assessment of psoriasis severity in Brazilian patients with chronic plaque psoriasis attending outpatient clinics: a multicenter, population-based cross-sectional study. J Dermatolog Treat. 2018;29(8):775–785. https://doi.org/10.1080/09546634.2018.1466023

Priyadarssini M, Chandrashekar L, Rajappa M. Effect of methotrexate monotherapy on T-cell subsets in the peripheral circulation in psoriasis. Clin Exp Dermatol. 2019;44(5):491–497. https://doi.org/10.1111/ced.13795

Banerjee S, Das S, Roy AK, Ghoshal L. Comparative effectiveness and safety of methotrexate versus PUVA in severe chronic stable plaque psoriasis. Indian J Dermatol. 2021;66(4):371–377. https://doi.org/10.4103/ijd.IJD_492_20

Tsentemeidou A, Sotiriou E, Sideris N, Bakirtzi K, Papadimitriou I, Lallas A, et al. Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature. Dermatol Pract Concept. 2022;12(4):e2022179. https://doi.org/10.5826/dpc.1204a179

Gao JC, Wu AG, Contento MN, Maher JM, Cline A. Apremilast in the treatment of plaque psoriasis: differential use in psoriasis. Clin Cosmet Investig Dermatol. 2022;15:395–402. https://doi.org/10.2147/CCID.S266036

Megna M, Fabbrocini G, Camela E, Cinelli E. Apremilast efficacy and safety in elderly psoriasis patients over a 48-week period. J Eur Acad Dermatol Venereol. 2020;34(11):e705–e707. https://doi.org/10.1111/jdv.16443

Afra TP, Razmi TM, Dogra S. Apremilast in psoriasis and beyond: big hopes on a small molecule. Indian Dermatol Online J. 2019;10(1):1–12. https://doi.org/10.4103/idoj.IDOJ_437_18

Srivastava D, Krishna A, David A. A comparative study of the efficacy of methotrexate versus methotrexate with apremilast in moderate to severe chronic plaque psoriasis. Indian J Dermatol. 2023;68(4):393–398. https://doi.org/10.4103/ijd.ijd_1002_22

Hassanandani T, Panda M, Jena AK, Raj C. Methotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis: a prospective, randomised, assessor-blinded, comparative study. Indian J Dermatol Venereol Leprol. 2023;89(2):213–220. https://doi.org/10.25259/IJDVL_843_2021

Shetty VH, Goel S, Babu AM, Eram H. A comparative study of the efficacy and safety of oral apremilast versus oral methotrexate in patients with moderate to severe chronic plaque psoriasis. Int J Res Dermatol. 2018;4(4):563–569. https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20184462

Khan S, Farooq M, Tariq F, Ahmed R, Aslam MA. Efficacy and safety of apremilast in moderate to severe cases of chronic plaque psoriasis: a retrospective study. Biol Clin Sci Res J. 2023;2023:180. https://doi.org/10.54112/bcsrj.v2023i1.180

Khurram M, Ghafoor R, Qadir MZ, Phulpoto K, Iqra S, Jabeen N, et al. Comparison of efficacy of methotrexate vs apremilast in moderate to severe plaque psoriasis. J Popul Ther Clin Pharmacol. 2024;31:2943–2948. https://doi.org/10.53555/cjr0d282