Methotrexate versus hydroxycarbamide (hydroxyurea) as a weekly dose to treat moderate-to-severe chronic plaque psoriasis: A comparative study

Background: Literature is replete with reports on the therapeutic efficacy and toxicity of methotrexate or hydroxycarbamide for treating chronic plaque psoriasis but no comparative study on their efficacy/safety has been carried out. While methotrexate has long been used in weekly doses in the treatment of psoriasis, the efficacy of hydroxycarbamide as a weekly therapy remains universally unexplored. Methods: Two groups of 15 patients each having moderate-to-severe chronic plaque psoriasis were given weekly doses of methotrexate (15-20 mg/week) or hydroxycarbamide (3-4.5 g/week). The clinical response was assessed by the percentage reduction in the baseline PASI scores for the next 12 weeks. Results: At the end of 12 weeks, the mean percentage reduction in the PASI score was 77.28 +/- 18.80 in the methotrexate group and 48.47 +/- 26.53 in the hydroxycarbamide group. Ten (66.66%) patients in the methotrexate group achieved > 75% reduction in the PASI score, while in the hydroxycarbamide group only two (13.33%) patients showed similar results, signifying that methotrexate leads to a faster clearance of the disease. The methotrexate-related side effects, however, were also higher. Conclusions: Weekly doses of hydroxycarbamide can be used as an alternative to methotrexate in patients who either experience intolerable methotrexate side effects or have achieved its recommended cumulative dose.