Source: DGNews  |  Posted 1 year ago

PARIS -- July 9, 2010 -- The optimal time to discontinue methotrexate for treatment of psoriasis is at 12 weeks of therapy, according to findings presented at the 3rd International Congress on Psoriasis.

"Due to the lack of clinical studies it would be useful for practitioners to know how long methotrexate should be continued in a sub-optimal responder before changing to another therapy," said lead study author Jean-Hilaire Saurat, MD, Cantonal Hospital University of Geneva, Geneva, Switzerland.

"The objective of our study was to determine the relationship between methotrexate dosing and improvement in psoriasis for patients in the CHAMPION study," he said.

CHAMPION was a 16-week randomised, controlled trial of patients with moderate to severe psoriasis receiving therapy with adalimumab. Analysis of data from the methotrexate arm of CHAMPION provides insight into when methotrexate should be discontinued in patients with suboptimal response.

Patients received either placebo, adalimumab, or weekly oral methotrexate dosed at 7.5 mg at weeks 0 and 1; 10 mg at weeks 2 and 3; and 15 mg at weeks 4 through 7.

Patients were grouped into 3 categories, according to the Psoriasis Area and Severity Index (>=PASI 50 response) at weeks 8 and 12.

Methotrexate dosage remained at 15 mg for week 8 in Psoriasis Area and Severity Index (PASI) 50 responders (group A).

For others, methotrexate dosage increased to 20 mg at week 8 and was maintained until week 12 for PASI 50 responders (group B) or increased to 25 mg for patients with week-12 PASI <50 responders (group C).

In this analysis, only 27% of the patients receiving methotrexate achieved a PASI >= 75 at week 16 with a maximum dosage per protocol methotrexate of 15 mg per week.

Those patients with a suboptimal response to 20 mg of methotrexate at week 12 derived little benefit by week 16 from increasing the dosage to 25 mg.

"In the treatment of psoriasis with the regimen used in CHAMPION trial, week 12 may be a useful decision-making point for discontinuation of methotrexate," said Dr. Saurat.

SOURCE: 3rd International Congress on Psoriasis