Comparative study of efficacy of methotrexate and apremilast in the treatment of moderate to severe plaque psoriasis

Amul Prathap, T (2020) Comparative study of efficacy of methotrexate and apremilast in the treatment of moderate to severe plaque psoriasis. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Psoriasis is a chronic inflammatory skin disease that affects around 1% to 3% of the population. Psoriasis vulgaris or plaque psoriasis, the most common form, accounts for more than 80% of psoriasis cases. Most patients are mildly affected and can be treated adequately with topical medication, but 10–20% of patients have moderate-to-severe disease and require phototherapy or systemic treatment. Methotrexate and Apremilast are well-known systemic therapies for moderate-to-severe chronic plaque psoriasis. AIM OF THE STUDY: To compare the efficacy of daily Apremilast with weekly Methotrexate in management of moderate to severe plaque psoriasis patient attending Dermatology Out-patient Department, Gov.Rajaji Hospital, Madurai. MATERIALS AND METHOD: A total of 40 patients with moderate-to-severe plaque psoriasis were included in the study. The psoriasis severity was evaluated by the psoriasis area and severity index (PASI). Baseline investigations was done initially before starting the treatment. The patients was divided into two groups; in one group A (20 patients) Methotrexate was started at dose of 7.5mg per week after the test dose of 2.5mg in first week. In other group B (20 patients) Apremilast was started at a dose of 10mg and titrated to a maximum of 30mg which is taken twice daily. Regular biweekly checkup done for 16 weeks looking for clinical improvement & adverse effects. Assessment done by Psoriasis area and severity index (PASI) score at 0, 1, 2, 3,4th month of treatment. Post treatment follow-up done for another 6months during which the patients was evaluated for duration of remission & relapse if any. The efficacy of the drugs was compared by using PASI75. RESULTS: ◈ Both methotrexate and Apremilast showed equal efficacy in the treatment of moderate to severe plaque psoriasis. ◈ Incidence of adverse effects are minimal or absent with methotrexate when compared to Apremilast at the end of 16 weeks. ◈ Apremilast showed very good and response to nail psoriasis than methotrexate. ◈ No significant difference was seen in both the groups in achieving PASI 75 at the end of 4 months. ◈ To the best of our knowledge ours is the only comparative study using low dose of methotrexate i.e 7.5mg/week. While all other studies used 15mg/week as an initial dose. ◈ Methotrexate is a cost effective drug available in our setting. Though it carries many adverse effects and life threatening toxicities, it can be used safely by frequent lab monitoring, low dose regimens and folic acid supplementation.

Item Type: Thesis (Masters)
Additional Information: 201730101
Uncontrolled Keywords: Methotrexate, psoriasis, Apremilast.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 02:17
Last Modified: 05 Feb 2021 02:17

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