Local experience on the use of Methotrexate in the treatment of Psoriasis in Hospital Sultanah Aminah, Johor Bahru
- Author:
Chong YT
;
Tey KE
;
Choon SE
- Publication Type:Journal Article
- Keywords:
Methotrexate, psoriasis, side effects
- From:Malaysian Journal of Dermatology
2010;25(-):1-6
- CountryMalaysia
- Language:English
-
Abstract:
Introduction The efficacy of methotrexate in the treatment of psoriasis is well established. However,
high-quality data concerning its efficacy and side effects are sparse. The initial administration dose
differs among various centres. In Hospital Sultanah Aminah, Johor Bahru, methotrexate is initiated
at a starting dose of 0.3mg/kg body weight weekly and is continued until significant clinical
response before being tapered to the lowest maintenance dose.
The aim of this study is to determine the profile of our local psoriasis patients treated with
methotrexate, their response to treatment, their tolerability and the side-effects experienced.
Methods This is a retrospective study of all patients who were on methotrexate from January 2005
to December 2008 at the Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru.
Results Out of a total of 128 patients, 111 were started on an initial dose of methotrexate of between
15mg/week to 25mg/week. The mean age was 43 years old. 56.8% (63) were males and 43.2% (48)
females. The mean body weight was 66 kg, ranging from 39 kg to 103 kg. Methotrexate was
indicated for moderate to severe psoriasis in 77.5% (86), psoriatic arthropathy in 7.2% (8) and 15.3%
(17) for both indications. Methotrexate was started as a first line in 57.7% (64) of patients, whereas,
19.8% (22) had received phototherapy, 14.4% (16) acitretin and 7.2% (8) cyclosporine in the past
prior to being given methotrexate. Good response was noted in 79.3%, (88) of patients, 17.7% (19)
moderate and 2.7% (3) had a poor response. Side-effects were noted in 19.8% (22) of patients within
the first 6 months, 12.6% (14) due to raised liver enzymes, 3.6% (4) to bone marrow suppression,
2.7% (3) to gastro-intestinal symptoms and 0.9% (1) to central nervous system symptoms.
Methotrexate was stopped due to adverse events in 15.3% (17) of patients.
Conclusion Methotrexate is effective in the treatment of psoriasis but is limited by side effects,
especially raised liver enzymes. However, most of the side effects are mild and reversible on
stopping the drug.
