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Updated: May 29, 2026

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
11:39

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Published on: July 11, 2013

Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled

Mohammad Radmanesh1, Behnam Rafiei, Zahra-Beigum Moosavi

  • 1Department of Dermatology, Jondishapour University of Medical Sciences, Ahvaz, Iran. radmanesh_m@yahoo.com

International Journal of Dermatology
|September 29, 2011
PubMed
Abstract

Insights

Daily methotrexate (MTX) showed fewer side effects like nausea and fatigue in psoriasis patients. However, weekly MTX demonstrated greater clinical efficacy and fewer liver enzyme abnormalities.

Area of Science:

  • Dermatology
  • Pharmacology
  • Clinical Trials

Background:

  • Methotrexate (MTX) is a common psoriasis treatment, typically administered weekly due to concerns about daily dosing and hepatotoxicity.
  • Some patients may experience better tolerance with smaller, more frequent doses of MTX.

Purpose of the Study:

  • To compare the efficacy and toxicity of daily versus weekly oral methotrexate administration in patients with generalized plaque psoriasis.

Main Methods:

  • A randomized controlled trial involving 101 patients with generalized plaque psoriasis.
  • Patients received oral MTX 2.5 mg daily or weekly for 4 months.
  • Efficacy was assessed by changes in Psoriasis Area and Severity Index (PASI) scores.

Main Results:

  • Weekly MTX showed greater clinical efficacy, with more patients achieving significant PASI score improvement compared to daily dosing.
  • Transient increases in liver enzymes were observed in 45 patients on daily MTX and 33 on weekly MTX (P=0.11).
  • Adverse effects such as nausea, headache, fatigue, and gastrointestinal upset were significantly less common in the daily MTX group (4 patients) compared to the weekly group (30 patients) (P=0.0001).

Conclusions:

  • Daily MTX administration resulted in significantly fewer gastrointestinal and systemic side effects compared to weekly dosing.
  • Weekly MTX demonstrated superior clinical efficacy and a trend towards fewer liver enzyme abnormalities.
  • The choice between daily and weekly methotrexate for psoriasis should consider individual patient tolerance and treatment goals.

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