Assessment of the Therapeutic Aspect of Systemic Non-Biologic Anti-Psoriatic Treatment Modalities Used in Combination with Methotrexate

INTRODUCTION: Psoriasis is a common skin disease affecting 1% to 3% of the population worldwide. Combination therapy with traditional systemic anti-psoriatic agents offers a promising method for managing severe or recalcitrant psoriasis. AIMS AND OBJECTIVES: Lack of documented data regarding the efficacy and safety of combination therapy with methotrexate and other anti-psoriatic drugs in Iranian patients prompted us to design a study to investigate this issue in an Iranian educational hospital. MATERIALS AND METHODS: Records of psoriatic patients in Razi Hospital were reviewed retrospectively from October 2008 to March 2012. Forty-six patients who had received methotrexate in combination with other systemic anti-psoriatic agents were included in this study. Response to treatment was evaluated by PASI. Adverse reactions and the type of combination were recorded for all patients. RESULTS: Methotrexate was most frequently administered in combination with acitretin (n = 21) followed by cyclosporine (n = 11), and NB-UVB and PUVA (n = 6). Combinations were effective in the majority of patients; 46% showed good response (21 patients), 26% showed moderate response (12 patients) and 28% (13 patients) showed poor response who therefore switched to another treatment. The treatments were generally tolerable. Thirty-two patients experienced adverse events although none was severe or required hospitalization. The relative frequencies of adverse reactions were different among groups of patients receiving various therapeutic regimens. CONCLUSIONS: Methotrexate-combination therapy can offer an effective therapeutic regimen. However, the patients should be monitored for potential adverse effects. More studies are needed to determine the long-term safety and efficacy of these combinations.