Methotrexate: Revisited efficiency and safety of drug administration in psoriasis patients

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The article presents the current data of the literature on methotrexate, which is now one of the most commonly used preparation for the systemic treatment of patients with moderate to severe psoriasis. The following problems are under consideration: estimation by specialists of response to systemic psoriasis therapy and possible therapeutic strategies; selecting initial doses of methotrexate for the treatment of patients with psoriasis; the possibilities of combined use with genetically engineered biological agents and monitoring of therapy. The data from randomized clinical trials on the long-term continuous treatment with methotrexate (efficacy, safety); methods of its administration to patients and time and criteria for long-term effecasy are reported. There are presented the data on the mechanisms of methotrexate action and the new data about the impact on the adenosine metabolism and the ability of the preparation to modulate the inflammatory response in the skin of patients by inhibiting the cellular components of the inflammatory infiltrate in the skin (dendritic antigen-producing cells and T-lymphocytes), as well as the suppression of expression of some proinflammatory cytokines (IFN-y and IL17A).

About the authors

A. L. Bakulev

Saratov State Medical University named after V.I. Razumovsky

Author for correspondence.
Russian Federation


  1. Gottlieb A., Korman N. J., Gordon K. B. et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008; 58: 851-64.
  2. Augustin M., Reich K., Glaeske G. et al. M. Comorbidity and agerelated prevalence of psoriasis: analysis of health insurance data in Germany. Acta Derm Venereol 2010; 90: 147-51.
  3. Gladman D. D., Antoni C., Mease P. et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 Suppl 2): ii14-7.
  4. Baker C., Mack A., Cooper A. et al. Treatment goals for moderate to severe psoriasis: an Australian consensus. Australas J Dermatol 2013 May; 54 (2): 148-54.
  5. Dauden E., Puig L., Ferrândiz C. et al. Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol 2016 Mar; 30 (Suppl 2): 1-18.
  6. Sterry W., Barker J., Boehncke W. H. et al. Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol 2004 Aug; 151 (Suppl 69): 3-17.
  7. Thagi D. Long-term data in the treatment of psoriasis. Br J Dermatol 2008 Aug; 159 (Suppl 2): 18-24.
  8. Montaudie H., Sbidian E., Paul C. et al. Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol 2011 May; 25 (Suppl 2): 12-8.
  9. Dogra S., Mahajan R. Systemic methotrexate therapy for psoriasis: past, present and future. Clin Exp Dermatol 2013 Aug; 38 (6): 573-88.
  10. Yelamos O., Puig L. Systemic methotrexate for the treatment of psoriasis. Expert Rev Clin Immunol 2015 May; 11 (5): 553-63.
  11. Mrowietz U., Kragballe K., Reich K. et al. Definition of treatment goals for moderate to severe psoriasis: a European consensusArch Dermatol Res 2011 Jan; 303 (1): 1-10.
  12. Mrowietz U. Implementing treatment goals for successful long-term management of psoriasis.J Eur Acad Dermatol Venereol 2012 Mar; 26 (Suppl 2): 12-20.
  13. Oji V., Luger T.A. The skin in psoriasis: assessment and challenges. Clin Exp Rheumatol 2015 Sep-Oct; 33 (5 Suppl 93): S14-9.
  14. Nast A., Gisondi P., Ormerod A. D. et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris-Update 2015-Short version-EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2015 Dec; 29 (12): 2277-94.
  15. Nast A., Jacobs A., Rosumeck S., Werner R. N. Methods Report: European S3-Guidelines on the systemic treatment of psoriasis vulgaris-update 2015-EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2015 Dec; 29 (12): e1-22.
  16. Nast A., Boehncke W. H., Mrowietz U. et al. German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res 2012 Mar; 304 (2): 87-113.
  17. Carretero G., Puig L, Dehesa L. et al. Guidelines on the use of methotrexate in psoriasis. Actas Dermosifiliogr 2010 Sep; 101 (7): 600-13.
  18. Smith C., Chandler D., Hepple P. et al. Psoriasis: assessment and management. NICE Clinical guideline. Published: 24 October 2012 nice.
  19. Псориаз. Федеральные клинические рекомендации. Дерматовенерология 2015: Болезни кожи. Инфекции, передаваемые половым путем. 5-е изд., перераб. и доп. М: Деловой экспресс 2016;. 415-470.
  20. Reich K., Langley R. G., Papp K. A. et al. A 52-week trial comparing briakinumab with methotrexate in patients with psoriasis.N Engl J Med 2011 Oct 27;365 (17): 1586-96.
  21. Barker J., Hoffmann M., Wozel G. et al. Efficacy and safety of infliximab vs. methotrexate in patients with moderate-to-severe plaque psoriasis: results of an open-label, active-controlled, randomized trial (RESTORE1). Br J Dermatol 2011 Nov; 165 (5): 1109-17.
  22. Saurat J. H., Stingl G., Dubertret L. et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol 2008 Mar; 158 (3): 558-66.
  23. Hassan W. Methotrexate and liver toxicity: role of surveillance liver biopsy. Conflict between guidelines for rheumatologists and dermatologists. Ann Rheum Dis. 1996 May; 55 (5): 273-5.
  24. Gossec L., Smolen J. S., Ramiro S. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis 2015; 0:1-12.
  25. Coates L. C., Kavanaugh A., Mease P. J. et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Treatment Recommendations for Psoriatic Arthritis 2015 [abstract]. Arthritis Rheumatol. 2015; 67 (Suppl 10).
  26. Warren R. B., Mrowietz U., von Kiedrowski R. et al. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2016 Dec 21. pii: S0140-6736 (16) 32127-4.
  27. Nestle F. O., Kaplan D. H., Barker J. Psoriasis. N Engl J Med. 2009 Jul 30; 361 (5): 496-509.
  28. Kim J., Krueger J. G. The immunopathogenesis of psoriasis. Dermatol Clin. 2015 Jan; 33 (1):13-23.
  29. Warren R. B., Grifiths C. E. M. Systemic therapies for psoriasis: methotrexate, retinoids, and cyclosporine. Clin Dermatol. 2008; 26: 438-47.
  30. Genestier L., Paillot R., Fournel S. et al. Immunosuppressive properties of methotrexate: apoptosis and clonal deletion of activated peripheral T cells. J Clin Invest. 1998; 102: 322-8.
  31. Torres-Älvarez B., Castanedo-Cazares J. P., Fuentes-Ahumada C., Moncada B. The effect of methotrexate on the expression of cell adhesion molecules and activation molecule CD69 in psoriasis. J Eur Acad Dermatol Venereol. 2007; 21: 334-9.
  32. Sigmundsdottir H., Johnston A., Gudjonsson J. E. et al. Methotrexate markedly reduces the expression of vascular E-selectin, cutaneous lymphocyte-associated antigen and the numbers of mononuclear leucocytes in psoriatic skin. Exp Dermatol. 2004; 13: 426-34.
  33. Cronstein B. N., Naime D., Ostad E. The anti-inlammatory effects of methotrexate are mediated by adenosine. Adv Exp Med. 1994; 370: 411-6.
  34. Johnston A., Gudjonsson J. E., Sigmundsdottir H. et al. The anti-inlammatory action of methotrexate is not mediated by lymphocyte apoptosis, but by the suppression of activation and adhesion molecules. Clin Immunol. 2005; 114: 154-63
  35. Gladman D. D. Should methotrexate remain the first-line drug for psoriasis? Lancet. 2016 Dec 21. pii: S0140-6736 (16) 32574-0
  36. WHO. Global report on psoriasis. 2016. http:// pdf?ua=l(accessed April 1, 2016)

Copyright (c) 2017 Bakulev A.L.

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