Comparing routes of administration of methotrexate in psoriasis patients

Methotrexate is the most commonly used systematic drug, in both oral and subcutaneous form, in the treatment of psoriasis. A prospective, randomised, single-blinded study found that the efficacy and safety of methotrexate were not associated with the route of administration.

The FDA-approved drug methotrexate is used to treat moderate-to-severe psoriasis. It is believed to exert both antiproliferative and immunomodulatory effects and can be given either orally or subcutaneously. However, the route of administration of methotrexate has not been intensively studied for efficacy and side effects [1].

Therefore, Mr Ishan Agrawal (Siksha O Anusandhan University Bhubaneswar, India) and his team aimed to compare the effectiveness and side effects of oral versus subcutaneous methotrexate in chronic plaque psoriasis. In a prospective, comparative, single-blinded study (CTRI/2020/07/026598), adult patients (n=100) were randomised to receive oral methotrexate or subcutaneous methotrexate weekly for 24 weeks. The starting dose was 7.5–10 mg/week and could be increased with 2.5mg/week mg monthly depending on clinical response. Psoriasis was assessed by different methods, including Psoriasis Area Severity Index (PASI), Physician Global Assessment (PGA) score, Medical Adherence Score (MAS), and Dermatology Life Quality Index (DLQI) with dermoscopic and photographic evaluation at monthly intervals.

The oral methotrexate and subcutaneous methotrexate group showed similar age distribution and 26% versus 30% women, respectively. At 24 weeks, the mean difference in PASI and PGA from baseline was not significant. MAS increased from baseline to week 24 in both groups (P<0.001), while DLQI decreased in both groups (P=0.039) with a larger difference for the subcutaneous group.

At 6 months of therapy, oral and subcutaneous methotrexate had similar efficacy. However, a faster decline in PGA at week 8 was seen for subcutaneous methotrexate. Both routes of administration did not show any side effects that have not previously been reported with methotrexate. Improved MAS and DLQI were seen for the subcutaneous route.

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   1. Agrawal I, et al. A Prospective Randomised Comparative Study On The Efficacy And Safety Profile Of Oral Versus Subcutaneous Methotrexate In Patients Of Moderate To Severe Chronic Plaque Psoriasis. Abstract 208. ICD 2021, 10-13 November 2021.

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Posted on 2 December 20212 December 2021