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Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials
BACKGROUND: Methotrexate (MTX) has been used to treat psoriasis for over half a century. Even so, clinical data characterising its efficacy and safety are sparse. OBJECTIVE: In order to enhance the available evidence, we conducted two meta-analyses, one for efficacy and one for safety outcomes, resp...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864230/ https://www.ncbi.nlm.nih.gov/pubmed/27168193 http://dx.doi.org/10.1371/journal.pone.0153740 |
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author | West, Jonathan Ogston, Simon Foerster, John |
author_facet | West, Jonathan Ogston, Simon Foerster, John |
author_sort | West, Jonathan |
collection | PubMed |
description | BACKGROUND: Methotrexate (MTX) has been used to treat psoriasis for over half a century. Even so, clinical data characterising its efficacy and safety are sparse. OBJECTIVE: In order to enhance the available evidence, we conducted two meta-analyses, one for efficacy and one for safety outcomes, respectively, according to PRISMA checklist. (Data sources, study criteria, and study synthesis methods are detailed in Methods). RESULTS: In terms of efficacy, only eleven studies met criteria for study design and passed a Cochrane risk of bias analysis. Based on this limited dataset, 45.2% [95% confidence interval 34.1–60.0] of patients achieve PASI75 at primary endpoint (12 or 16 weeks, respectively, n = 705 patients across all studies), compared to a calculated PASI75 of 4.4 [3.5–5.6] for placebo, yielding a relative risk of 10.2 [95% C.I. 7.1–14.7]. For safety outcomes, we extended the meta-analysis to include studies employing the same dose range of MTX for other chronic inflammatory conditions, e.g. rheumatoid arthritis, in order not to maximise capture of relevant safety data. Based on 2763 patient safety years, adverse events (AEs) were found treatment limiting in 6.9 ± 1.4% (mean ± s.e.) of patients treated for six months, with an adverse effect profile largely in line with that encountered in clinical practice. Finally, in order to facilitate prospective clinical audit and to help generate long-term treatment outcomes under real world conditions, we also developed an easy to use documentation form to be completed by patients without requirement for additional staff time. LIMITATIONS: Meta-analyses for efficacy and safety, respectively, employed non-identical selection criteria. CONCLUSIONS: These meta-analyses summarise currently available evidence on MTX in psoriasis and should be of use to gauge whether local results broadly fall within outcomes. |
format | Online Article Text |
id | pubmed-4864230 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-48642302016-05-18 Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials West, Jonathan Ogston, Simon Foerster, John PLoS One Research Article BACKGROUND: Methotrexate (MTX) has been used to treat psoriasis for over half a century. Even so, clinical data characterising its efficacy and safety are sparse. OBJECTIVE: In order to enhance the available evidence, we conducted two meta-analyses, one for efficacy and one for safety outcomes, respectively, according to PRISMA checklist. (Data sources, study criteria, and study synthesis methods are detailed in Methods). RESULTS: In terms of efficacy, only eleven studies met criteria for study design and passed a Cochrane risk of bias analysis. Based on this limited dataset, 45.2% [95% confidence interval 34.1–60.0] of patients achieve PASI75 at primary endpoint (12 or 16 weeks, respectively, n = 705 patients across all studies), compared to a calculated PASI75 of 4.4 [3.5–5.6] for placebo, yielding a relative risk of 10.2 [95% C.I. 7.1–14.7]. For safety outcomes, we extended the meta-analysis to include studies employing the same dose range of MTX for other chronic inflammatory conditions, e.g. rheumatoid arthritis, in order not to maximise capture of relevant safety data. Based on 2763 patient safety years, adverse events (AEs) were found treatment limiting in 6.9 ± 1.4% (mean ± s.e.) of patients treated for six months, with an adverse effect profile largely in line with that encountered in clinical practice. Finally, in order to facilitate prospective clinical audit and to help generate long-term treatment outcomes under real world conditions, we also developed an easy to use documentation form to be completed by patients without requirement for additional staff time. LIMITATIONS: Meta-analyses for efficacy and safety, respectively, employed non-identical selection criteria. CONCLUSIONS: These meta-analyses summarise currently available evidence on MTX in psoriasis and should be of use to gauge whether local results broadly fall within outcomes. Public Library of Science 2016-05-11 /pmc/articles/PMC4864230/ /pubmed/27168193 http://dx.doi.org/10.1371/journal.pone.0153740 Text en © 2016 West et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article West, Jonathan Ogston, Simon Foerster, John Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title | Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title_full | Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title_fullStr | Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title_full_unstemmed | Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title_short | Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials |
title_sort | safety and efficacy of methotrexate in psoriasis: a meta-analysis of published trials |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864230/ https://www.ncbi.nlm.nih.gov/pubmed/27168193 http://dx.doi.org/10.1371/journal.pone.0153740 |
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