As a Korean War-era drug that long ago became a generic, methotrexate has missed out on much of the modern clinical trial research that guides our thinking about more recent treatments. But this workhorse drug is still commonly prescribed for psoriasis and psoriatic arthritis (among other diseases), making continued research on it quite valuable. Now, a team of researchers has reviewed methotrexate usage that was part of a clinical trial of Humira (adalimumab), and the study offers some useful guidance for what to do when methotrexate treatment is started but does not appear to be working.
The researchers found that based on the dosing in that study, those patients who had not responded adequately at week 12 to methotrexate derived little benefit from continuing on to week 16.
One of the difficult decisions in psoriasis treatment is when to discontinue a treatment. Often there is some response but it is simply not adequate. Do you stick with it a bit longer or try something else? Generally, we believe that some patients and physicians are jumping among treatments too quickly, and we will be writing more on that in the weeks ahead. But this study suggests that for those who are ‘failing’ on methotrexate at week 12, it might be time to consider alternatives, rather than simply stay the course.
It is important to note that you should not go cold turkey on methotrexate without medical supervision, as it can cause a psoriasis flare, or worsening. But at week 12 it might make sense to work with your doctor to begin weaning or tapering off of methotrexate and onto something else. Also, note that different dosing might result in a different result, and also, importantly, that in psoriatic arthritis, many experts believe it can take up to six months to get the full benefit of methotrexate treatment.
Category: Psoriasis Research, Treatment, psoriatic arthritis
Tags: methotrexate
