Efficacy, safety and discontinuation of methotrexate for psoriasis: two retrospective research

Abstract
Background: Methotrexate (MTX) was recognized as the first-line treatment of psoriasis, while the research of its clinical condition is sparse in China.
Objective: We aimed to assess the efficacy, adverse events (AEs), withdrawal reasons and other information during or after the MTX-treatment.
Methods: 188 outpatients recruited from our hospital for the first retrospective study, and 186 MTX ex-users for the second study using both online and offline questionnaires. The qualitative and quantitative data were analyzed by t-test, One-Way ANOVA and 2-test.
Results: MTX reached 36.5% PASI75 and 46.5% “improvement ≥75%” self-assessment. Drug survival was correlated with the AEs occurrence (P=0.010), not efficacy. The common reason for withdrawal were fear (24.2%), inefficacy (21.0%), intolerance (17.2%) and inconvenience (14.0%). The inefficacy impacted the satisfaction and willingness to accept MTX in the future (P=0.023, P<0.001).
Limitations: The limitation of our studies is relatively small sample size.
Conclusion: MTX had 36.5-46.5% response rate in psoriasis. 67.7% suffered from more than one AE during the therapy with the most common AE 29.0% gastrointestinal (GI) symptoms. Gender and age had relativity with GI symptoms and relapse respectively (P=0.044, P=0.01). The most important factor of withdrawal was fear in the real-world practice.