A Comparison of Efficacy and Adverse Reactions between Methotrexate and Cyclosporine A

Kim, Sang Yub; Yun, Sook Jung; Lee, Jee Bum; Kim, Seong Jin; Won, Young Ho; Lee, Seung Chul

Abstract

BACKGROUND
Psoriasis is a chronic inflammatory dermatosis and various topical or systemic drugs should be selected depending on severity.
OBJECTIVE
The purpose of this study was to compare the efficacy and adverse reactions of methotrexate (MTX) and cyclosporine A (CsA) in the treatment of moderate-to-severe plaque psoriasis.
METHODS
A retrospective analysis of the therapeutic efficacy of MTX and CsA was performed on 81 patients (MTX 30, CsA; 51) with moderate-to-severe plaque psoriasis. The MTX treatment was administered in weekly doses of 2.5 mg-7.5 mg up to 3 times every 12 hours. The CsA treatment was administered at daily doses of 1.5-5 mg/kg. Regular follow-up and laboratory tests were performed to evaluate the efficacy and adverse reactions of MTX and CsA.
RESULTS
Reach to PASI 50 was observed in 93% of patients in the MTX-treated group with an average-time of 4.8 weeks, and in 70% of patients in the CsA-treated group with an average-time of 7.1 weeks. Among nine patients who were switched from MTX to CsA, 55.6% had improved with CsA treatment in 6.6 weeks. In contrast, among the 22 patients who were switched from CsA to MTX, 77.3% had improved with MTX treatment in 5.4 weeks. Adverse reactions to MTX and CsA were observed in 40% and 25% of the treated patients, respectively, most of which were mild and transient. Average relapse-time in patients improved by the drugs was 20.4 weeks in the MTX group and 15.4 weeks in the CsA group.
CONCLUSION
Treatment with MTX is found to be a more effective systemic agent than CsA in both therapeutic response and length of relapse-free periods.