Apremilast or Methotrexate: The Arrows in the Quiver for Psoriasis

Area of Science:

• Dermatology
• Pharmacology
• Clinical Trials

Background:

• Psoriasis incidence is rising in the Indian subcontinent, exacerbated by climate.
• Methotrexate and apremilast are current treatments for chronic plaque psoriasis.
• Comparative studies on these treatments are limited.

Purpose of the Study:

• To compare the efficacy and safety of apremilast versus methotrexate for chronic plaque psoriasis.
• Primary objective: assess change in Psoriasis Area and Severity Index (PASI) at 6 months.
• Secondary objectives: evaluate change in Dermatology Life Quality Index (DLQI) and adverse events.

Main Methods:

• Randomized, open-label, 24-week study in Cuttack, India.
• Participants received either methotrexate (10-15mg weekly) or apremilast (10-30mg twice daily).
• Efficacy and safety assessed at baseline and Weeks 8, 16, and 24.

Main Results:

• 70 out of 85 participants completed the study.
• Apremilast showed a significantly greater median reduction in PASI scores (-37.25) compared to methotrexate (-34.75) (p=0.006).
• No significant difference in DLQI score changes (p=0.079); no serious adverse events observed.

Conclusions:

• Apremilast demonstrated superior efficacy over methotrexate in improving PASI scores for psoriasis.
• Both treatments were safe and well-tolerated, with no serious adverse events.
• Further research may explore long-term outcomes and patient-reported quality of life.