Drug survival for methotrexate in psoriasis patients

[Fred]

This study evaluated drug survival for methotrexate (MTX) monotherapy in patients with plaque psoriasis.

Quote:

---

Background:
Drug survival is useful to evaluate long-term drug performance in daily practice. The aim of this study was to evaluate drug survival for methotrexate (MTX) monotherapy in patients with plaque-type psoriasis.

Methods:
We reviewed 3,512 follow-up charts of patients with psoriasis at five tertiary referral centers between January 2012 and January 2020. We analyzed baseline data and treatment outcomes of patients under MTX monotherapy. Drug survival was analyzed using Kaplan-Meier and Cox regression analyses.

Results:
Patients with psoriasis who were treated with MTX monotherapy were enrolled (N = 649). The median duration of drug survival was 15 months (95% CI: 13.2–16.8). The overall drug survival rate was 54.7%, 17.4%, and 8% after 1, 3, and 5 years, respectively. The main reasons for discontinuation were adverse effects (n = 209, 32.2%) and inefficacy (n = 105, 15.6%). Based on multivariate Cox regression analysis, the presence of nausea/vomiting (HR: 2.01, 95% CI: 1.49–2.71; P < 0.001) was observed as a statistically significant risk factor for drug discontinuation. Age over 50 years (HR: 0.68, 95% CI: 0.48–0.97; P = 0.03) and using MTX dose ≥15 mg/weekly were positive predictors for drug survival (HR: 0.72, 95% CI: 0.54–0.95; P = 0.02).

Conclusions:
The average drug survival of MTX was 15 months. MTX is still the first-line treatment of moderate-to-severe plaque psoriasis, as highlighted in guidelines. To prevent premature discontinuation, physicians need to look at the response time of at least 16–24 weeks, especially when a stepwise dose increment is used. The presence of nausea/vomiting seemed to be associated with an approximately twofold risk of discontinuation.

Source: onlinelibrary.wiley.com

*Early view funding unknown

[Caroline]

That is a average that is a lot shorter than I had thought.

[jiml]

I would have guessed a short duration on methotrexate as it mirrors my experience of nausea and sickness I don't think I made a year on it myself

[Caroline]

I would have guessed a short duration on methotrexate as it mirrors my experience of nausea and sickness I don't think I made a year on it myself

My personal experience was much much shorter, but I regularly hear from people who use it for a very long time.
But I see in the writing, that drug survival with people over 50, is more positive.

[KatT]

I had no side effect whatsoever and was on it for a little over a year

I stopped because my dermatologist at the time wanted to send me for a liver biopsy....just as a precaution.

Went back on it after a year break but wasn't doing anything for my PSA.

[Caroline]

I had no side effect whatsoever and was on it for a little over a year

I stopped because my dermatologist at the time wanted to send me for a liver biopsy....just as a precaution.

Went back on it after a year break but wasn't doing anything for my PSA.

I am not amazed that it did nothing for your Psoriatic Arthritis.
There is a publication of a research in Rheumatology. 2012;51(8), that says that MTX is useless with Psoriatic Arthritis. Strange enough all Rheumatologists inevitable start with giving MTX.
Now I must say, that there are people with PSA, who do seem to have positive results with it, but me also I did not have any positive effect out of it, only negative ones, exactly as this drug survival publication states.

[Turnedlight]

That is about how long it worked for me.

I stopped because it stopped actually working and my P got worse despite trying higher doses of mtx towards the end.

[D Foster]

I stopped using it in the end as it gradually stopped working however I was five years on oral and three years on injection. It worked for me though at times it certainly caused problems like nausea . I had blood tests every twelve weeks and liver/kidney tests were fine up until the last few months before I stopped.