Researchers performed a head-to-head trial comparing oral methotrexate and subcutaneous methotrexate in severe psoriasis. After analysis, they concluded that subcutaneous methotrexate was advantaged compared with oral methotrexate. Their results were published in Dermatologic Therapy.

The single-blinded, randomized controlled trial included 100 adult patients with severe psoriasis. A total of 50 patients received oral methotrexate 0.3 mg/kg/week with a weekly maximum of 25 mg for 12 weeks or until they achieved a 90% reduction in Psoriasis Area Severity Index score (PASI90). The remaining 50 patients received the same schedule of subcutaneous methotrexate. Both cohorts were then tapered 5 mg every 2 weeks.

Participants’ PASI and Dermatology Life Quality Index (DLQI) scores were collected monthly over the 24 weeks of follow-up. Notably, a higher number of patients in the subcutaneous group (n=31; 78%) achieved PASI90 compared with the oral group (n=31; 62%; P=.08). The subcutaneous group also achieved PASI90 significantly faster (P<.001).

In addition, the subcutaneous group had a significantly higher percentage of declines in DLQI compared with the oral group (P=.003). Researchers noted that overall side effects were similar between the 2 groups (P=.31), but the subcutaneous group had significantly less frequent gastrointestinal side effects. The relapse rate between responders of each group was comparable (P=.33).

Overall, the authors supported the advantaged efficacy and comparable safety of subcutaneous methotrexate vs oral methotrexate for patients with severe psoriasis who are eligible for systemic treatments.

Reference: Dogra S, Singh N, Kumar S, Narang T, Handa S. Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis. Dermatol Ther. 2022;35(8):e15656. doi:10.1111/dth.15656