Methorexate drug survival rate is low in psoriasis patients

[Fred]

This study looked at the drug survival rate of methotrexate in psoriasis patients and suggests only 15% stay on it past 5 years.

Quote:

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Background:
As methotrexate (MTX) is a widely used treatment for psoriasis, it is important to gain insight into the reasons for the discontinuation of MTX and to understand the determinants for drug survival.

Objectives:
To describe 5-year drug survival for MTX in patients with psoriasis, split according to different reasons for discontinuation, and to identify the determinants for drug survival.

Methods:
Data were extracted from a prospective psoriasis registry of patients treated with MTX (MTX-CAPTURE). Drug survival was analysed using Kaplan–Meier estimates and the determinants for discontinuation were analysed using Cox regression analysis. Analyses were split according to the reason for discontinuation: side-effects or ineffectiveness.

Results:
We included 85 patients treated with MTX, with a maximum treatment duration of 5·2 years. The overall drug survival rates were 63%, 30% and 15% after 1, 3 and 5 years, respectively. The median survival was 1·8 years. Overall, 55 patients (65%) discontinued MTX for the following reasons: side-effects (35%), ineffectiveness (26%), combination of side-effects and ineffectiveness (13%), other reasons (16%) and 11% were lost to follow-up. The most reported side-effects were gastrointestinal symptoms, despite the use of folic acid in 99% of patients. Based on univariate analysis, a high Psoriasis Area and Severity Index score and a high score on the visual analogue scale for disease severity at baseline were possible determinants for a short drug survival.

Conclusions:
Drug survival of MTX was low with 15% of patients ‘on drug’ after 5 years. Side-effects alone or in combination with inadequate disease control were more important in the context of treatment discontinuation than inadequate disease control alone.

Source: onlinelibrary.wiley.com

*Funding unknown.

[jiml]

It doesn't surprise me that not many 15% were still taking it after 5 years with many opting out early in the treatment...myself I stuck it for around 8 or 9 months before deciding I would rather have the disease than the Methotrexate side effects

[Fred]

I'm surprised that many lasted that long on the poison myself.

[mataribot]

Most people can get 2 - 4 years on the drug. At that point, the risk of liver damage increases and typically discontinued by the doctor. That is why when MTX is used as a contaminant with a biologics it typically give at lower doe (10) in an attempt to increase long term use.

[Caroline]

Indeed I am as not surprised as you are.

For me it already felt very quickly as very bad. My quick stop has at least saved me from liver damage.

[D Foster]

Stop being so prejudice the lot of you , It's not a poison no more than all other drugs and I wonder if they did the same study and added PsA in with the P how many would claim inadequate control as on PsA it is much more effective. I lasted over 9 years on it with no liver/kidney damage at all but had to stop because of side effects . I don't think 85 patients of which they lost 11% is a very comprehensive study at all.

I had really bad problems with cyclosporine and if you look closely at that shaking, headache, dizziness, unusual growth of body hair, nausea/vomiting, diarrhea, stomach upset, or flushing may occur.
Unusual growth and swelling of the gums may occur. This medication may raise your blood pressure. signs of kidney problems (such as a change in the amount of urine), signs of liver disease (such as nausea/vomiting that doesn't stop, dark urine, yellowing eyes/skin, stomach/abdominal pain), easy bruising/bleeding, unusual tiredness, muscle weakness/spasms, slow/irregular heartbeat, numb/tingling skin, severe leg pain.
Get medical help right away if you have any very serious side effects, including: mental/mood changes (such as confusion, difficulty concentrating), vision changes, problems with speech, clumsiness, loss of coordination, weakness on one side of the body, chest pain, seizures.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

I will stick with MTX if you don't mind.

[Fred]

Good to see members defending it Dave. That is what the forum is about, and it's great to get different opinions.

However I stand by my thoughts.

[D Foster]

Good to see members defending it Dave. That is what the forum is about, and it's great to get different opinions.  

However I stand by my thoughts.

Well everyone to their own opinions Fred, it mentions unusual hair growth with cyclosporine but mine started to fall out so even the listed side effects are not comprehensive. I was convinced that I was dead on that stuff.

[mataribot]

It's not being prejudiced - MTX isn't a long term drug. It's not the patients that more than likely requesting a new treatment. It's the doctor saying that's enough. My rheumatologist said he discontinues treatment at four years.

[Turnedlight]

It had a short life for me, not because of side effects though (I was coping with them, although when I came off I realised just how much they affected me) but because it simply stopped working.