Methotrexate Usage Trends in Psoriasis in a Tertiary Care Hospital: A Retrospective Study

Introduction: Methotrexate has been successfully used for treating Psoriasis over the past six decades. There is a range of methotrexate dosing regimens for psoriasis and the clinical data illustrating its efficacy and safety are inadequate. Aim: To evaluate the utilisation of methotrexate prescription trends, the time taken for the lesions to resolve, evaluate the safety, efficacy and its rational use in patients with psoriasis. Materials and Methods: It was a hospital based retrospective study in which medical records of the patients having psoriasis from pre-filled proformas attending the outpatient department during January 2015 to December 2017 were analysed. Patients of both genders with age ranging between 18 years to 60 years were included. Methotrexate was initiated in a dose of 5-10 mg/week (maximum upto 20 mg), depending on the Psoriasis Area and Severity Index (PASI) score and the dose was increased or decreased based on the treatment efficacy. The mean baseline PASI scores were calculated and mean PASI scores following the Methotrexate treatment were evaluated. The drug safety was evaluated by patient's clinical symptoms and relevant lab investigations. Results: In this study, 86 patients with psoriasis were included with mean age being 40.73 +/- 5.353 years, male:female ratio was 2:1. The mean baseline PASI scores showed clear and comparable improvement of the psoriatic plaque lesions from (mean +/- SD) a PASI score of 18.12 +/- 10.07 to 5.50 +/- 1.97. Out of 86 patients, 13 patients achieved a score of <PASI 50; 58 between PASI 50-75; 15 patients >PASI 75 indicating a clinically meaningful endpoint. The mean clearance time for the lesions was 16 weeks. Adverse effect being dose dependent, the most common was gastrointestinal disorders, myelosuppresion and long term adverse effect was hepatotoxitiy. Conclusion: The present study provides an overview for methotrexate dosing for future consenses and guidance in daily practice. Methotrexate still remains a near to gold standard treatment for psoriasis, inducing quick remission and delays relapse. PASI reduction was observed during each month of therapy. If given with proper monitoring will have significantly low adverse effects.