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Updated: Jun 21, 2025

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Debate at the GRAPPA 2023 Annual Meeting: Should Methotrexate Be the First Systemic Therapy in Psoriatic Disease?
Arianna J Zhang1, Joseph F Merola2, William Tillett3
1A.J. Zhang, BA, Department of Dermatology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Abstract:
Despite substantial evidence that methotrexate (MTX) has inferior efficacy, safety, and tolerability compared to newer systemic therapies, MTX remains one of the most commonly prescribed first-line systemic therapies for psoriatic arthritis worldwide and for psoriasis in some countries. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting in Dublin, Ireland, Drs. William Tillett and Joseph Merola engaged in debate over whether MTX should be the first systemic therapy used in psoriatic disease (PsD). Each presented evidence-based arguments, incorporating multiple data sources, including clinical trials, in support for and against MTX's status as first-line systemic therapy for PsD. This article summarizes their debate for the broader PsD community.
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