Treatment of Chronic Plaque Psoriasis with Etanercept and Methotrexate

Authors

  • Rana Khalid Obeed Al-Anbar Health Directorate, Ministry of Health, Al-Anbar, Iraq.
  • Husam Ali Salman College of Medicine, University of Baghdad, Baghdad, Iraq.

DOI:

https://doi.org/10.22317/imj.v4i4.966

Keywords:

Etanercept, Methotexate, Psoriasis

Abstract

Objectives: The aim of study is to assess the efficacy of methotrexate and etanercept in the treatment of chronic plaque psoriasis.

Methods: This therapeutic, interventional comparative single center study was carried out at the Center of Dermatology and Venereology, Baghdad Teaching Hospital, from January 2015 –July 2017. A total of 62 patients were enrolled; divided in to two groups. Group I: Thirty three patients (23 males and 10 females), their ages ranged between15 and 65 years mean ±SD 33.13±13.07, recieved etanercept 50mg twice weekly for 3 months then once weekly thereafter. Group II: Twenty nine patients (19 males and 10 females), their ages ranged between15 and 62 years mean ± SD 38.16±15.2 ,received  methotrexate 15 mg per week for six monthes then tapered. Both groups were followed up monthly for 6 months and their PASI score, DLQI, side effect and pictures were recorded.

Results: Seven patients defaulted from the study for unknown reason,30 patients completed in etanercept group, while 25 patients completed in methotrexate group. After 12 weeks the PASI score decrease from base line 19.13±10.67 to 6.38±4.96 and then to 3.34±5.38 after 24 weeks treatment with Etanercept  compaired to reduction in PASI score from base line 18.97±10.54 to 5.72± 4.8 to 2.95±-6.01 after 12 weeks and 24 weeks respectively. There is significant statistical effect in the two groups.

Conclusions: both are effective monotherapy for patients with moderate to severe plaque psoriasis with tolerable side effects.

References

1. Alissa C. , Abby S. , Van V. . Introduction: History of psoriasis and psoriasis therapy: Treatment of Psoriasis. Birkhäuser Verlag AG 2008; 1:1-9.
2. Raychaudhuri SP, Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol 2001; 15(1):16-17.
3. Zalzala HH, Abdullah GA, Abbas MY, Mohammedsalih HR, Mahdi BM. Relationship between human leukocyte antigen DRB1 and psoriasis in Iraqi patients. Saudi Med J. 2018;39(9):886-890.
4. Christophers E. Psoriasis—epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26:314–20.
5. Dommasch ED, Li T, Okereke OI, Li Y, Qureshi AA, Cho E. Risk of depression in women with psoriasis: a cohort study. Br J Dermatol. 2015;173(4):975-980.
6. Chaibub SCW. High prevalence of psoriasis in a family from Goiás State, Brazil. An Bras Dermatol. 2019 Mar-Apr;94(2):245-246.
7. Muluk NB, Altın F, Cingi C. Role of Superantigens in Allergic Inflammation: Their Relationship to Allergic Rhinitis, Chronic Rhinosinusitis, Asthma, and Atopic Dermatitis. Am J Rhinol Allergy. 2018 Nov;32(6):502-517.
8. Vittorio G, Simonetti S, and Stagni G. Clinical improvement of psoriasis AIDS patients effectively treated with combnation antiretroviral therapy. Scand J Infect Dis 2006; 38:78-5.
9. Ferreira BI, Abreu JL, Reis JP, Figueiredo AM. Psoriasis and Associated Psychiatric Disorders: A Systematic Review on Etiopathogenesis and Clinical Correlation. J Clin Aesthet Dermatol. 2016;9(6):36-43.
10. Herron MD, Hinckley M, Hoffman MS, et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol. 2005;141:1527–34.
11. Grffith CEM, Barker JNWN.Psoriasis. In: Burns T, Breathnach S, Cox N, Griffiths C. Rook’s Textbook of dermatology, 8th ed., Singapore, Wiley-Blackwell publishing company2010;1:20.1-20.60.
12. Johann EG. James TE. Psorasis. In: Wolf K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s Dermatology In general medicine .8th ed., New York: Mc Graw Hill 2012; 1:18:197-231.
13. Carretero G., Puig L. , Dehesa L. , Carrascosa JM., Ribera M ,et al. Guidelines on the Use of Methotrexate in Psoriasis. Actas Dermo-sifiliografica. 2010;101(7):600–613.
14. Brimhall AK , King LN , Licciardone JC, et al. Safety and efficacy of alefacept, efalizumab, etanercept and infliximab in treating moderate to severe plaque psoriasis : ameta-analysis of randomized controlled trials . Br J Dermatol. 2008 ; 159: 274-85.
15. Babino G, Esposito M, Bianchi L, Giunta A. Long-term treatment with etanercept monotherapy in a hemodialyzed patient with moderate-to-severe plaque-type psoriasis and psoriatic arthritis. G Ital Dermatol Venereol. 2018 Dec;153(6):882-884.
16. Hongbo, Y., Thomas, C. L., Harrison, M. A., Salek, M. S. & Finlay, A. Y. Translating the science of quality of life into practice: What do dermatology life quality index scores mean? Journal of Investigative Dermatology 125, 659–664 (2005).
17. Xia L, Li R, Wang Y, Lin Z, Zheng J, Li X, Lu Q, Zhang J, Jin H, Fu L, Zhang X, Liu Y, Yang S, Xiao F, Gao XH. Efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment in the treatment of mild to moderate psoriasis vulgaris: A randomized, single-blind, multicenter clinical trial. Dermatol Ther. 2018 Sep;31(5):e12632.
18. Menter A, Korman NJ.,Elmets CA., Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Guidelines of care for the management of psoriasis and psoriatic arthritis, section 5. Guidelines of care for the management of psoriasis with physiotherapy and photochemotherapy. J Am Acad Dermatol 2010;62:114-35.
19. Sivamani RK, Correa G, Ono Y, Bowen MP, Raychaudhuri SP, Maverakis E. Biological therapy of psoriasis. Indian J Dermatol. 2010;55(2):161-170.
20. Tournier A, Khemis A, Maccari F, Reguiai Z, Bégon E, Fougerousse AC, Amy de la Breteque M, Beneton N, Parier J, Boyé T, Avenel-Audran M, Girard C, Pallure V, Perrot JL, Bastien M, Mahé E, Beauchet A; GEM Resopso. Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France. Ann Dermatol Venereol. 2019 Feb;146(2):106-114.
21. Bo Ri Kim, Jungyoon ohn, Chong won choi, Sang Woong Youn. Methotrexate in a real-world psoriasis treatment, it is really a dangerous medication for all?.Ann Dermatol,2017;29(3):346-8.
22. Kim A Papp. The safety of etanercept for the treatment of plaque psoriasis, their Clin Risk Manage, 2017;3(2):245-8.
23. Murdaca G, Negrini S, Magnani O, Penza E, Pellecchio M, Puppo F. Impact of pharmacogenomics upon the therapeutic response to etanercept in psoriasis and psoriatic arthritis. Expert Opin Drug Saf. 2017 Oct;16(10):1173-1179.
24. Gordon KB, Betts KA, Sundaram M, Signorovitch JE, Li J, Xie M, Wu EQ, Okun MM. Poor early response to methotrexate portends inadequate long-term outcomes in patients with moderate-to-severe psoriasis: Evidence from 2 phase 3 clinical trials. J Am Acad Dermatol. 2017 Dec;77(6):1030-1037.
25. Rodríguez-Zúñiga MJM, Cortez-Franco F, Qujiano-Gomero E. Split doses of Methotrexate in patients with moderate to severe Psoriasis. Actas Dermosifiliogr. 2017 Jul-Aug;108(6):603-604.
26. Nakao M, Asano Y, Kamata M, Yoshizaki A, Sato S. Successful treatment of palmoplantar pustular psoriasis with brodalumab. Eur J Dermatol. 2018 Aug 1;28(4):538-539.

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Published

2020-12-26

How to Cite

1.
Obeed RK, Salman HA. Treatment of Chronic Plaque Psoriasis with Etanercept and Methotrexate. Iraq Med J [Internet]. 2020 Dec. 26 [cited 2024 Nov. 4];4(4). Available from: https://iraqmedj.org/index.php/imj/article/view/966

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