Evaluation of methotrexate and cyclosporine for severe psoriasis: A retrospective analysis from tertiary hospital in Indonesia
DOI:
https://doi.org/10.66344/jpad.v33i1.1997Abstract
Background Psoriasis is an autoimmune disease manifested as chronic, recurrent thick red scaly plaques. Cyclosporine and methotrexate have been used as therapy for severe psoriasis since decades. This study aims to evaluate the clinical outcome of methotrexate and cyclosporine as treatment for severe psoriasis.
Methods A three-year retrospective analysis was undertaken to examine the medical records of hospitalized patients with severe psoriasis. This study evaluated outcomes such as psoriasis area and severity index (PASI) and length of hospital stay (LOS).
Results Twenty-six patients were included in the study. Mean PASI reduction was 42.8% (± 24.64), with greater reduction in cyclosporine group (mean 54.88±12.73%) than that in methotrexate group (mean 43.22±24.4%). Patients in cyclosporine group stayed longer (18.83±9.39 days) than patients in methotrexate group (11.65±5.91 days).
Conclusion Methotrexate and cyclosporine treatment are effective for severe psoriasis. However, the hospital stays for patients receiving cyclosporine treatment might be longer.
References
1. Gudjonsson JE, Elder JT. Psoriasis. In: Kang S, Amagai M, et al., editors. Fitzpatrick’s dermatology in general medicine. 9th ed. New York: McGraw Hill; 2019. p. 457-97.
2. Organization WH. Global Report on Psoriasis. World Heal Organ are available WHO website or can be Purch from WHO Press World Heal Organ [Internet]. 2016;978:48. Available from: (www.who.int/about/licensing/%5Cncopyright_form/en/index.html)%00
3. Fransiska A, Surya Husada M, Effendy E. The differences of depressive symptoms by gender in people with psoriasis. Asian J Pharm Clin Res. 2018;11:42-5.
4. Heydendael VM, Spuls P, Opmeer BC, De Borgie C, et al., Goldschmidt WF, et al. Methotrexate versus cyclosporine in moderate-to-severe chronic plaque psoriasis. N Engl J Med. 2003;349(7):658-65.
Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L36975998%0Ahttp://dx.doi.org/10.1056/NEJMoa021359
5. Sandhu K, Kaur I, Kumar B, Saraswat A. Efficacy and safety of cyclosporine versus methotrexate in severe psoriasis: A study from North India. J Dermatol. 2003;30(6):458–63.
6. Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol. 2009; 60(5):824-37.
Available from: http://dx.doi.org/10.1016/j.jaad.2008.11.906
7. PERDOSKI PDSK dan KI. Psoriasis. In: Widaty S, Soebono H, Nilasari H, Listiawan MY, et al., editors. Panduan Praktik Klinis bagi dokter spesialis kulit dan kelamin di Indonesia. Jakarta, indonesia: PERHIMPUNAN DOKTER SPESIALIS KULIT DAN KELAMIN INDONESIA (PERDOSKI); 2017. p. 230–40.
8. Flytström I, Stenberg B, Svensson Å, Bergbrant IM. Methotrexate vs. ciclosporin in psoriasis: Effectiveness, quality of life and safety. A randomized controlled trial. Br J Dermatol. 2008;158(1):116-21.
9. Gümüşel M, Özdemir M, Mevlitoǧlu Ä, Bodur S. Evaluation of the efficacy of methotrexate and cyclosporine therapies on psoriatic nails: A one-blind, randomized study. J Eur Acad Dermatology Venereol. 2011;25(9):1080–4.
10. Mohanan S, Ramassamy S, Chandrashekar L, Thappa DM. A retrospective analysis of combination methotrexate-cyclosporine therapy in moderate-severe psoriasis. J Dermatolog Treat. 2014;25(1):50-3.
11. Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, et al., Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: Meta-analysis of randomized controlled trials. Br J Dermatol. 2014; 170(2):274-303.
12. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. J Am Med Assoc. 2020;323(19):1945-60.
13. Imafuku S, Zheng M, Tada Y, Zhang X, et al., Asian consensus on assessment and management of mild to moderate plaque psoriasis with topical therapy. J Dermatol. 2018;45(7):805-11.
14. Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, et al., S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. JDDG - J Ger Soc Dermatology. 2012;10(Suppl 2):S1-S95.
15. Elmets CA, Lim HW, Stoff B, Connor C, et al., Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81(3):775-804.
Available from: https://doi.org/10.1016/j.jaad.2019.04.042
16. Papp K, Gulliver W, Lynde C, Poulin Y, et al., Canadian guidelines for the management of plaque psoriasis: Overview. J Cutan Med Surg. 2011;15(4):210-9.
17. Mrowietz U, De Jong EMGJ, Kragballe K, Langley R, et al., A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatology Venereol. 2014;28(4):438-53.
18. Hsu DY, Gordon K, Silverberg JI. Serious infections in hospitalized patients with psoriasis in the United States. J Am Acad Dermatol. 2016;75(2):287-96.
Available from: http://dx.doi.org/10.1016/j.jaad.2016.04.005
19. Vensel E, Hilley T, Trent J, Taylor JR, et al. Sustained improvement of the quality of life of patients with psoriasis after hospitalization. J Am Acad Dermatol. 2000;43(5):858-60.
20. Sampogna F, Chren MM, Melchi CF, Pasquini P, et al., Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis. Br J Dermatol. 2006;154(2):325-31.
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