Methotrexate for psoriasis review

[Fred]

Hmmmmmmmmmmmmmm I'll just pass on the news as I still don't think methotrexate should be used for psoriasis.

Quote:

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Abstract:

The Australasian Psoriasis Collaboration reviewed methotrexate (MTX) in the management of psoriasis in the Australian and New Zealand setting. The following comments are based on expert opinion and a literature review. Low-dose MTX (< 0.4 mg/kg per week) has a slow onset of action and has moderate to good efficacy, together with an acceptable safety profile. The mechanism of action is anti-inflammatory, rather than immunosuppressive.

For pretreatment, consider testing full blood count (FBC), liver and renal function, non-fasting lipids, hepatitis serology, HbA1c and glucose. Body mass index and abdominal circumference should also be measured. Optional investigations in at-risk groups include an HIV test, a QuantiFERON-TB Gold test and a chest X-ray. In patients without complications, repeat the FBC at 2–4 weeks, then every 3–6 months and the liver/renal function test at 3 months and then every 6 months.

There is little evidence that a MTX test dose is of value. Low-dose MTX rarely causes clinically significant hepatotoxicity in psoriasis. Most treatment-emergent liver toxicity is related to underlying metabolic syndrome and non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. Alcohol itself is not contraindicated, but should be limited to < 20 mg/day. Although MTX is a potential teratogen post-conception, there is little evidence for this pre-conception. MTX does not affect the quality of sperm. There is no evidence that MTX reduces healing, so there is no specific need to stop MTX peri-surgery. MTX may be used in combination with cyclosporine, acitretin, prednisone and anti-tumour necrosis factor biologics.

Source: onlinelibrary.wiley.com

*Early view funding unknown

[jiml]

Hmmmmmmmm indeed it's true Methotrexate in a low dose as is prescribed for psoriasis can be very effective , but I'm not a great lover of it ..... As I felt awful on it and persevered and got clearance but in the end the side effect of nausea and generally feeling unwell was worse than the psoriasis......yes it's a cheap solution...but there are far less toxic alternatives in my opinion that should be used in its place

[Caroline]

Quote:

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Low-dose MTX rarely causes clinically significant hepatotoxicity in psoriasis.

Rarely?
I am curious how rarely.

[Bill]

30%. Hardly worth mentioning really.

<Long term therapy with methotrexate has been associated with development of fatty liver and hepatic fibrosis and, in rare instances, portal hypertension and symptomatic cirrhosis. Symptoms are usually absent until cirrhosis is present, and liver tests are typically normal or minimally and transiently elevated. Routine monitoring of patients with regular liver biopsies done at 1 to 2 year intervals or with cumulative methotrexate doses of 1 to 10 grams demonstrates that approximately 30% of patients develop mild-to-moderate histological abnormalities (fat, cellular unrest, mild inflammation, nuclear atypical) and 2 to 20% of patients develop some degree of hepatic fibrosis.>

[Caroline]

Bill, sometimes I am not sure if you are being ironic.

[jiml]

Bill, sometimes I am not sure if you are being ironic.  

Methinks he is

[mataribot]

The problem with the data presented in this thread is the missing data from people who don't take the drug. Then we can take an educated guess of how big the problem really is. It's probably in the article somewhere, I am just to lazy.

[Fred]

It's probably in the article somewhere, I am just to lazy.

No you're not lazy the information isn't in the post. What I posted is only a small abstract as the full article is pay for view, and it's not worth paying for.

[D Foster]

Long-term Safety of MTX

The profile of side effects of MTX has been studied over 25 years, with very few clinically important adverse effects in the weekly low doses used for RA/PsA/P therapy. Indeed, MTX courses show some of the longest continuation rates reported in clinical medicine, obviously as a result of both its efficacy and safety. The safety profile of MTX indicates that it is among the safest of all drugs used for the treatment of chronic inflammatory arthritis.

I still think that MTX has it's place and is not as bad as it's made out, people are very prejudice against it and even though it has some side effects when you look at some of the other treatments available it is, on balance, no worse than others. It is used quite a lot more than many other treatments so really I think that it is difficult to evaluate constructively,I used it for 9 years with increasingly bad side effects but it did work especially for the PsA , the side effects for the Cyclosporine were far worse than MTX . The long term effects for a lot of the new treatments are not known as they have not been out long enough to do the same in depth of research that MTX has had .

[mataribot]

I am going to have to disagree - I have read enough articles to suggest the actual % of liver problems is 15 to 25. Now, that is not counting alcohol use, but that would be nearly impossible to rule out. That means as many as a quarter of people who take it long term will have some sort of liver problems. My rheumatologist says most people get about four years on the drug and need to switch because of complications.