Methotrexate in psoriasis treatment: a single-center retrospective study (2018–2020)

BACKGROUND: Despite the wide range of therapeutic options for moderate-to-severe psoriasis, dermatologists still experience some difficulties in its treatment. To date, methotrexate (MTX) is the most commonly prescribed systemic drug for the treatment of psoriasis worldwide. Given its low cost and good effectiveness, this drug has been continuously used along with recently developed highly effective biological drugs. According to international guidelines, MTX is a drug of choice for the treatment of moderate-to-severe psoriasis. AIM: To evaluate the efficacy and safety of MTX in the treatment of moderate-to-severe psoriasis. MATERIALS AND METHODS: We conducted a retrospective study on patients with psoriasis who had been admitted to the Dermatology Department of Sechenov University in 2018–2020. Based on electronic medical documents of the patients, we analyzed the demographic characteristics, disease duration, comorbidities, psoriasis severity before and after treatment with MTX, and its side effects. RESULTS: The study included 655 patients with moderate (373; 57%) and severe (282; 43%) psoriasis. Of these patients, 279 (42.6%) were women aged 18–79 years, and 376 (57.4%) were men aged 18–86 years (median age: 44.9 and 41.6 years, respectively). The duration of stay in the hospital varied from 17 days to 21 days. In all cases, topical therapy was performed in addition to systemic drugs administration or phototherapy. The most commonly prescribed medication was MTX 326 (49.7%) in a dose of 25 mg/week. A total of 29 patients received MTX as monotherapy. However, the drug was most often prescribed in combination with phototherapy: MTX + PUVA (n = 140) and MTX + UVB-311 nm (n = 157). At the time of discharge from the hospital, 53% of patients in the MTX group had improved, 47% had a significant improvement. in the MTX group + PUVA – in 10.3; 75.7; 14% of patients, respectively; in the MTX + UVB-311 nm group – in 17.4; 71.2; 11.4% of patients, respectively. The side effects were mild and did not lead to treatment discontinuation. CONCLUSION: MTX is a highly effective therapeutic option with a good safety profile and is a confirmed drug of choice for the treatment of moderate-to-severe psoriasis.