Methotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis: A prospective, randomised, assessor-blinded, comparative study

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dc.contributor.authorHassanandani, Trashitaen_US
dc.contributor.authorPanda, Maitreyeeen_US
dc.contributor.authorJena, Ajaya Kumaren_US
dc.contributor.authorRaj, Chinmoyen_US
dc.date.accessioned2023-08-10T07:30:52Z
dc.date.available2023-08-10T07:30:52Z
dc.date.issued2023-04
dc.description.abstractBackground: Palmoplantar psoriasis is a chronic debilitating condition which significantly impairs quality of life. Objectives: To assess the efficacy and safety of the combination of apremilast and methotrexate compared with methotrexate monotherapy in the treatment of palmoplantar psoriasis. Also, to study the impact on treatment on the Dermatology Life Quality Index and Palmoplantar Quality of Life Index. Methods: A total of 64 patients were randomised to two groups in a 1:1 ratio - Group A received both methotrexate and apremilast in combination, while Group B received only methotrexate, for 16 weeks. The primary endpoints were the mean score of Modified Palmoplantar Psoriasis Area and Severity Index at week 16, the proportion of patients achieving modified palmoplantar psoriasis area severity index-75 and/or Palmoplantar Psoriasis Physician Global Assessment score 0/1 at week 16. Results: A significantly higher proportion of patients in Group A achieved Modified Palmoplantar Psoriasis Area and Severity Index-75 at week 16 (43% in Group A vs 30% in Group B). The Modified Palmoplantar Psoriasis Area and Severity Index score was significantly lower in the combination group at week 16 (4.03 ± 2.05 in Group A and 5.89 ± 2.31 in Group B, P-value = 0.002). About 80% of patients in the combination group with baseline Palmoplantar Psoriasis Physician Global Assessment ?3 achieved Palmoplantar Psoriasis Physician Global Assessment 0/1 compared to 60% in Group B. The combination group showed a significantly higher reduction in Dermatology Life Quality Index and Palmoplantar Quality of Life Index scores compared to the methotrexate alone group (P-value = 0.025). No notable adverse events were observed. Limitation: The limitations of the study were single blinding, small sample size and a lack of longer follow up to assess the rate of relapse. We did not account for attrition during sample size calculation. Also, due to the paucity of data regarding the use of apremilast in palmoplantar psoriasis, definitive comparisons could not be made with previous studies. Conclusion: The combination of apremilast and methotrexate has superior efficacy and a similar safety profile as compared to methotrexate monotherapy for the treatment of moderate to severe palmoplantar psoriasisen_US
dc.identifier.affiliationsDepartment of Dermatology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, Indiaen_US
dc.identifier.citationHassanandani, Trashitaen_US
dc.identifier.citationPanda, Maitreyeeen_US
dc.identifier.citationJena, Ajaya Kumaren_US
dc.identifier.citationRaj, Chinmoy. Methotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis: A prospective, randomised, assessor-blinded, comparative study. Indian Journal of Dermatology, Venereology and Leprology. 2023 Apr; 89(2): 213-220en_US
dc.identifier.issn0973-3922
dc.identifier.issn0378-6323
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/223112
dc.languageenen_US
dc.publisherScientific Scholaren_US
dc.relation.issuenumber2en_US
dc.relation.volume89en_US
dc.source.urihttps://doi.org/10.25259/IJDVL_843_2021en_US
dc.subjectMethotrexateen_US
dc.subjectapremilasten_US
dc.subjecttreatment of psoriasisen_US
dc.subjectpalmoplantar psoriasisen_US
dc.titleMethotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis: A prospective, randomised, assessor-blinded, comparative studyen_US
dc.typeJournal Articleen_US
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