The use of self-administered subcutaneous methotrexate for the treatment of psoriasis

For nearly 5 decades, methotrexate has been the backbone of moderate-to-severe psoriasis treatment. The benefits of methotrexate therapy include reliable efficacy, low cost, relative ease of administration, and its usefulness as part of combination therapy regimens, making it a drug of choice for treating psoriasis. While methotrexate can be administered orally, intravenously, or intramuscularly, the self-administered subcutaneous use of the drug is the most advantageous route. Subcutaneous methotrexate is associated with fewer adverse events and higher absorption rates, accompanied by bioavailability that is both linear and predictable throughout the range of possible doses. In addition, the subcutaneous route, when compared with oral administration, facilitates improved efficacy by promoting higher intracellular levels of long-chain methotrexate polyglutamates. Taken together, these features allow patients the highest probability of a successful therapeutic experience. Subcutaneous methotrexate should be considered a viable option for the appropriate patient with moderate-to-severe psoriasis.