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Adalimumab Monotherapy vs Adalimumab With Methotrexate for Psoriasis
Zenas Z N Yiu1,2, Catherine H Smith3, Philip Laws4
1Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
JAMA Dermatology
|June 4, 2025
Summary
Adding methotrexate to adalimumab did not improve its effectiveness or persistence in plaque psoriasis patients. This study found no significant differences in drug survival or Psoriasis Area and Severity Index scores between monotherapy and combination therapy.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Psoriasis is a chronic autoimmune disease affecting skin.
- Adalimumab is a biologic therapy for moderate to severe psoriasis.
- The role of concomitant methotrexate with adalimumab for psoriasis is not well-defined.
Purpose of the Study:
- To evaluate the effectiveness and persistence of adalimumab monotherapy versus adalimumab with methotrexate in plaque psoriasis patients.
- To compare drug survival, Psoriasis Area and Severity Index (PASI75) scores, and safety profiles between the two treatment groups.
Main Methods:
- A target trial emulation cohort study using the Biologics and Immunomodulators Register (2007-2021).
- Compared adalimumab monotherapy (40 mg every other week) with adalimumab plus methotrexate (weekly).
- Analyzed drug survival at 1 and 3 years, PASI75 at 1 and 3 years, serious adverse events, and drug concentrations/antibodies using weighted regression models.
Main Results:
- No significant difference in adalimumab drug survival at 1 year (78.1% vs 79.1%).
- No significant difference in PASI75 achievement at 1 year (52.0% vs 49.4%) or 3 years (32.4% vs 37.2%).
- Similar rates of serious adverse events; lower antidrug antibody levels observed with combination therapy.
Conclusions:
- Concomitant methotrexate does not appear to enhance the effectiveness or persistence of adalimumab in plaque psoriasis.
- Adalimumab monotherapy demonstrates comparable outcomes to combination therapy regarding efficacy and safety.
- Further research may explore specific patient subgroups or alternative combination strategies.
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