How Do Methotrexate and Cyclosporine Compare?Researchers Evaluate Differences for First Time
First posted August 26, 2003
For the first time, a clinical research trial has compared the traditional systemic therapies methotrexate and cyclosporine in their treatment of psoriasis. They are two of the main therapies used for moderate to severe psoriasis and psoriatic arthritis.
Methotrexate has been used since the 1950s and cyclosporine since the 1990s to treat psoriasis. Researchers from the University of Amsterdam, the Netherlands, recently compared the efficacy, side effects, quality of life effects and costs of methotrexate and cyclosporine for people with moderate to severe plaque psoriasis.
The study, published in the Aug. 13 issue of the New England Journal of Medicine, involved 88 patients with moderate to severe chronic plaque psoriasis with an average age of 40. Forty-four patients used methotrexate with an initial dose of 15 milligrams (mg) per week. The other half used cyclosporine with an initial dose of 3 mg per killigram (kg) per day. The researchers looked at their difference in PASI (a measure of psoriasis severity) after 16 weeks of treatment. Follow-up was at 36 weeks.
After 16 weeks of treatment, researchers saw no significant difference between the two medications' effect on psoriasis. Seventeen patients (40%) in the methotrexate group and 14 patients (33%) in the cyclosporine group had almost complete remission (defined as a reduction in the baseline score for the psoriasis area-and-severity index [PASI] of >90%). Partial remission (PASI>75%) was achieved in 60% and 71% in the methotrexate and cyclosporine groups, respectively. Time to reach remission (clearance of psoriasis), quality of life scores and the Physician Global Assessment were comparable for both therapies.
Patients on methotrexate did have more cases of nausea, whereas cyclosporine users had more cases of headache.
The researchers concluded that there were no significant efficacy differences between methotrexate and cyclosporine in the treatment of moderate to severe chronic plaque psoriasis.
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