Support for methotrexate use in PsA patients
medwireNews: Findings from an observational study suggest that methotrexate treatment, with a dose-escalation strategy targeting remission, improves the joint and skin manifestations of psoriatic arthritis (PsA).
Liza Rajasekhar and team from Nizam’s Institute of Medical Sciences in Hyderabad, India, explain that despite methotrexate being recommended as first-line therapy for PsA, “there is limited published evidence of its efficacy” at present.
The researchers analyzed data from 73 patients aged an average of 44 years who were treated at their center between 2015 and 2016. All participants were given oral methotrexate at a starting dose of 15 mg/week, with dose escalation at 1, 3, or 6 months to target remission according to a Clinical Disease Activity Index for PsA score of 4 points or lower. Methotrexate doses above 20 mg/week were given by subcutaneous injection, and the average dose was 17.5 mg/week.
As reported in Rheumatology, patients experienced significant improvements in multiple domains of PsA from baseline to the 9-month follow-up. For example, average tender and swollen joint counts decreased from 9.67 to 1.42 and 3.52 to 0.15, respectively, while average Leeds Dactylitis Index scores decreased from 36.06 to 0.00 points, and Leeds Enthesitis Index scores from 1.60 to 0.10 points. Mean patient and physician global activity scores improved from a respective 5.73 and 3.70 points at baseline to 1.67 and 0.96 points at 9 months.
Rajasekhar and colleagues say that improvements in all of these disease measures were observed at the 3-month follow-up, with further improvements occurring at the 6- and 9-month timepoints, and that similar findings were observed when patients were categorized according to methotrexate exposure prior to entering the study.
The investigators remark that “no notable adverse effects” occurred during the study. One patient experienced transaminitis that resolved spontaneously, while one developed coronary artery disease before being lost to follow-up.
Noting that their study did not include a control arm, the team concludes that “[t]here is strong need of a [randomized controlled trial] with an adequate dose of [methotrexate] to establish its efficacy in non-articular domains of PsA.”
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