Relapse in psoriasis with two different tapering regimens of methotrexate: A randomized open-label controlled study.
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Date
2015-03
Authors
Singh, Satyendra Kumar
Rai, Tulika
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Abstract
Background: Systemic therapy with methotrexate is a very useful modality in psoriasis, but
relapses can occur soon after stopping it. Aim: To compare the relapse rates in psoriasis with
two different tapering regimens of methotrexate after control is achieved. Methods: This was a
randomized open-label controlled study, and patients of chronic plaque psoriasis with psoriasis
area and severity index (PASI) >10 were included. Methotrexate 0.3 mg/kg weekly was given
and the PASI calculated every 2 weeks. After achieving a 75% reduction in the PASI (PASI-75),
patients were assigned randomly in to one of three groups. In the half-dose group, the dose
of methotrexate was reduced to half and given weekly; in the 2-weekly group, the same dose
was given at 2-week intervals; in the control group, methotrexate was stopped. Patients were
followed up for 12 weeks. Results: Out of 141 registered patients, 81 were included: 27 in the
half-dose group, 28 in the 2-weekly group, and 26 in the control group. After further exclusions
due to adverse effects and loss to follow-up, the results were analysed for 16, 17 and 19 patients
respectively in the 3 groups. There was statistically a highly signifi cant difference in relapse rates
between the half-dose and control groups (P < 0.001), and a signifi cant difference between
the 2-weekly and control groups (P = 0.001). Relapse rates in the half-dose and 2-weekly
groups did not show a signifi cant difference (P = 0.680). Limitation: Many (35.8%) patients
were excluded and only 52 (64.2%) completed the study. Conclusion: There appears to be no
signifi cant difference in the frequency of relapse in psoriasis whether methotrexate is tapered
by halving the weekly dose or by doubling the interval between two doses, and both methods
led to fewer relapses than abrupt cessation of the drug.
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Keywords
Methotrexate, PASI-75, psoriasis, relapse, tapering
Citation
Singh Satyendra Kumar, Rai Tulika. Relapse in psoriasis with two different tapering regimens of methotrexate: A randomized open-label controlled study. Indian Journal of Dermatology, Venereology and Leprology. 2015 Mar-Apr; 81(2): 144-147.