Individualized Pharmacotherapy of Plaque Psoriasis with Oral Methotrexate: Fiction or Reality?


Authors: J. Chládek 1;  M. Šimková 2;  J. Vaněčková 2;  M. Hroch 1;  J. Ettler 2;  J. Vávrová 3;  K. Ettler 2
Authors‘ workplace: Ústav farmakologie, Lékařská fakulta, Hradec Králové přednosta doc. MUDr. Stanislav Mičuda, Ph. D. 1;  Klinika nemocí kožních a pohlavních, Fakultní nemocnice a Lékařská fakulta, Hradec Králové přednosta doc. MUDr. Karel Ettler, CSc. 2;  Ústav klinické biochemie a diagnostiky, Fakultní nemocnice a Lékařská fakulta, Hradec Králové přednosta doc. MUDr. Pavel Živný, CSc. 3
Published in: Čes-slov Derm, 87, 2012, No. 6, p. 221-228
Category: Pharmacologyand Therapy, Clinical Trials

Overview

Methotrexate (MTX) is an effective immunosuppressive drug for moderate-to-severe psoriasis. In an open prospective study patients with chronic plaque psoriasis (n = 25, aged 28–79 yr) were treated with oral methotrexate using an individualized dose guided by plasma concentrations and with folic acid in case the concentration of blood folates dropped below the lower limit of normal range. The aim was to study the relationship between changes in PASI (the Psoriasis Area and Severity Index) and concentrations of MTX polyglutamates (MTXPG) in erythrocytes and blood folates. After 26 weeks, PASI improved from the median of 13.5 (range 2.2–33) by 91% on the average and the frequency of PASI75 (improvement ≥ 75 %) was 76%. There was a correlation between PASI improvement and the ratio of concentrations MTXPG/folates (rs = 0. 51, P < 0.01). In patients experiencing PASI75, the ratio achieved 0.61 as compared to 0.26 in those with less improvement (P < 0.05). In conclusion, individual-tailored therapy with MTX and folic acid can improve the results in the remission-induction phase of psoriasis treatment. Its efficacy should be compared with other established drug regimens in controlled studies.

Key words:
psoriasis – PASI – methotrexate – folates


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Dermatology & STDs Paediatric dermatology & STDs
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