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. 2023 Jul-Aug;68(4):393-398.
doi: 10.4103/ijd.ijd_813_22.

A Comparative Study of the Efficacy of Methotrexate versus Methotrexate with Apremilast in Moderate to Severe Chronic Plaque Psoriasis

Divyanshu Srivastava  1 , Arvind Krishna  1 , Abhinav David  1
Affiliations

A Comparative Study of the Efficacy of Methotrexate versus Methotrexate with Apremilast in Moderate to Severe Chronic Plaque Psoriasis

Divyanshu Srivastava et al. Indian J Dermatol. 2023 Jul-Aug.

Abstract

Background: Psoriasis is an inflammatory systemic disease with a chronic relapsing course. Methotrexate, a dihydrofolate reductase inhibitor, and Apremilast, an oral phosphodiesterase type 4 inhibitor, are currently the mainstay drugs in the treatment of psoriasis.

Aims and objectives: To compare the efficacy of Methotrexate with a combination of Methotrexate and Apremilast in treating chronic plaque psoriasis.

Materials and methods: The present study was a prospective comparative study conducted among 40 patients, aged above 18 years, with clinically diagnosed psoriasis attending Dermatology OPD of a tertiary care hospital in North India. The study utilised a pre-structured proforma to record a detailed demographic profile and clinical examination related to chronic plaque psoriasis. The patients were divided into two groups of 20 each. Group A was treated with oral Methotrexate, while Group B was treated with oral Apremilast and Methotrexate, and they were evaluated every 4 weeks for 12 weeks. Necessary investigations were done wherever indicated.

Results: The male-to-female ratio was 1.35, and the majority (55.0%) of patients belonged to the age group of 31-50 years. 27.5% of patients had comorbidities like diabetes, hypertension, etc., The mean PASI score of group A at the first, second and third follow-ups was higher than that of group B. The reduction in mean PASI score was statistically significant in group B at successive follow-ups, with a percentage improvement of 89.4% at the end of 12 weeks.

Conclusions: When comparing monotherapy with methotrexate and multidrug therapy with Methotrexate and Apremilast, multidrug therapy had better efficacy.

Keywords: Apremilast; efficacy; methotrexate; psoriasis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Mean difference in PASI scores between group A and group B at subsequent follow-up visits
Figure 2
Figure 2
Clinical improvement in patient 1 (group A) from (a and b) first visit to (c and d) 12th week (upper body view)
Figure 3
Figure 3
Clinical improvement in patient 1 (group A) from (a and b) first visit to (c and d) 12th week (lower body view)
Figure 4
Figure 4
Clinical improvement in patient 2 (group A) from (a and b) first visit to (c and d) 12th week (upper body view)
Figure 5
Figure 5
Clinical improvement in patient 2 (group A) from (a and b) first visit to (c and d) 12th week (lower body view)
Figure 6
Figure 6
Clinical Improvement in patient 1 (group B) from (a and b) first visit to (c and d) 12th week (upper body view)
Figure 7
Figure 7
Clinical improvement in patient 1 (group B) from (a and b) first visit to (c and d) 12th week (lower body view)
Figure 8
Figure 8
Clinical improvement in patient 2 (group B) from (a and b) first visit to (c and d) 12th week (Upper Body View)
Figure 9
Figure 9
Clinical improvement in patient 2 (group B) from (a and b) first visit to (c and d) 12th week (lower body view)
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References

    1. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361:496–509. - PubMed
    1. Chang CA, Gottlieb AB, Lizzul PF. Management of psoriatic arthritis from the view of the dermatologist. Nat Rev Rheumatol. 2011;7:588–98. - PubMed
    1. Naldi L. Epidemiology of psoriasis. Curr Drug Targets Inflamm Allergy. 2004;3:121–8. - PubMed
    1. Tanew A, Radakovic-Fijan S, Schemper M, Hönigsmann H. Narrowband UV-B phototherapy vs photochemotherapy in the treatment of chronic plaque-type psoriasis: A paired comparison study. Arch Dermatol. 1999;135:519–24. - PubMed
    1. Schafer P. Apremilast mechanism of action and application to psoriasis and psoriatic arthritis. Biochem Pharmacol. 2012;83:1583–90. - PubMed