Comparison between methotrexate and apremilast in Psoriatic Arthritis-a single blind randomized controlled trial...

Area of Science:

• Rheumatology
• Clinical Immunology
• Pharmacology

Background:

• Psoriatic arthritis (PsA) is a chronic inflammatory condition affecting joints and entheses.
• Methotrexate and apremilast are established treatments for PsA, but direct comparative efficacy data is limited.

Purpose of the Study:

• To compare the efficacy and safety of methotrexate versus apremilast in adult patients with active psoriatic arthritis.
• To evaluate key clinical response measures including the composite disease activity score (cDAPSA) and American College of Rheumatology (ACR) 20 response.

Main Methods:

• A single-center, physician-blinded, parallel-group, randomized controlled trial.
• Recruited adult PsA patients meeting CASPAR criteria, naive to bDMARDs and JAK inhibitors.
• Assessed major cDAPSA response at 24 weeks as the primary outcome, with secondary outcomes including ACR 20, PASI, enthesitis, dactylitis, and HAQ-DI scores.

Main Results:

• 31 patients were randomized (15 apremilast, 16 methotrexate); 26 completed 24 weeks.
• No significant difference in major cDAPSA response at week 24 between apremilast (20%) and methotrexate (37.5%; p=0.433).
• Secondary outcomes and adverse events showed no significant differences between the groups.

Conclusions:

• Methotrexate and apremilast demonstrate comparable efficacy in treating active psoriatic arthritis over 24 weeks.
• Both agents are well-tolerated, with similar safety profiles in this patient cohort.
• Further research may explore long-term outcomes and specific patient subgroups.