Relapse in psoriasis with two different tapering regimens of methotrexate: a randomized open-label controlled study

Area of Science:

• Dermatology
• Pharmacology
• Clinical Trials

Background:

• Methotrexate is effective for psoriasis but relapses are common after discontinuation.
• Effective tapering strategies are needed to maintain remission and minimize psoriasis flare-ups.

Purpose of the Study:

• To compare relapse rates in psoriasis patients using two different methotrexate tapering regimens after achieving disease control.
• To evaluate the efficacy of dose reduction versus interval extension for methotrexate tapering.

Main Methods:

• A randomized controlled study involving 81 chronic plaque psoriasis patients with PASI >10.
• Patients received methotrexate 0.3 mg/kg weekly until PASI-75 was achieved.
• Three groups were formed: half-dose weekly, 2-weekly interval, and abrupt cessation (control).

Main Results:

• Relapse rates were significantly lower in both the half-dose (P < 0.001) and 2-weekly (P = 0.001) groups compared to the control group.
• No significant difference in relapse rates was observed between the half-dose and 2-weekly tapering groups (P = 0.680).
• A high percentage of patients (35.8%) were excluded, with 52 (64.2%) completing the study.

Conclusions:

• Both methotrexate tapering methods (dose halving or interval doubling) are effective in reducing psoriasis relapses compared to abrupt cessation.
• The frequency of relapse does not significantly differ between the two tested tapering strategies.
• These findings suggest that gradual methotrexate withdrawal can maintain disease control in psoriasis patients.