Methotrexate in psoriasis: 26 years’ experience with low‐dose long‐term treatment

作者：U-F Haustein, Manfred Rytter · 发表于：Journal of the European Academy of Dermatology and Venereology · 年份：2000 · DOI：10.1046/j.1468-3083.2000.00058.x · 被引用次数：187 · 研究领域：Psoriasis: Treatment and Pathogenesis、Rheumatoid Arthritis Research and Therapies、Spondyloarthritis Studies and Treatments

OBJECTIVE: To evaluate the efficacy, safety and side-effects of methotrexate (MTX) in psoriasis. DESIGN: A 26-year retrospective study. SETTING: Department of Dermatology, Leipzig University, Leipzig, Germany. PATIENTS: One hundred and fifty-seven patients with extensive plaque psoriasis, erythrodermic, pustular and arthropathic forms, were treated with low-dose methotrexate (15-20 mg maximum weekly dosage [Weinstein schedule]), the majority for long-term periods. The mean cumulative dose was 3394 mg, the mean duration 237 weeks. RESULTS: The effect of MTX treatment was good in 76%, moderate in 18% and poor in 6% of subjects; 61% experienced side-effects, most frequently due to liver function abnormalities, bone marrow suppression, nausea, gastric complaints and hair loss. In 20% of cases the subjects were forced to discontinue therapy; 9% refused therapy due to physical and psychological discomfort, 2% wanted to become pregnant, 16% were lost to follow-up, 6% died from multimorbidity and old age. Three subjects (2%) developed cancer of the lung, breast or cervix uteri, possibly in relation to long-term MTX treatment. Altogether there were no deaths or life-threatening side-effects attributable to MTX treatment, and no cases of progressive liver cirrhosis apart from two extensive skin necroses due to overdosage (misunderstanding, suicidal attempt) that were treated successfully with citrovorum factor. CONCLUSION: Low-dose MTX (<15-20 mg/week) is an effective therapy for exten...