Nasza Dermatologia Online (Sep 2015)

Weekly methotrexate versus daily isotretinoin to treat moderate-to-severe chronic plaque psoriasis: a comparative study

  • C. Abhinav,
  • Vikram K Mahajan,
  • Karaninder S. Mehta,
  • Pushpinder S. Chauhan,
  • Mrinal Gupta,
  • Mrinal Gupta

DOI
https://doi.org/10.7241/ourd.20154.106
Journal volume & issue
Vol. 6, no. 4
pp. 392 – 398

Abstract

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Introduction: There is paucity of data on efficacy of isotretinoin versus methotrexate in psoriasis patients. Aims: We compared the efficacy and safety of once a week methotrexate and daily isotretinoin for the treatment of moderateto-severe chronic plaque psoriasis. Methods: 43 (M: F 30:13) consenting patients having moderate-to-severe chronic plaque psoriasis were divided on alternate basis in Group-A for treatment with methotrexate (15mg/week) and Group-B for isotretinoin (30mg/d) therapy. The clinical response was assessed by the percentage reduction in the baseline PASI scores during next 12 weeks. Results: 14 patients in Group-A and 11 patients in Group-B completed the study. The mean percentage reduction in the PASI score was 79.78 ± 20.68 in the methotrexate group and 51.92 ± 23.83 in the isotoin group at the end of 12 weeks. Five patients in Group-A achieved >75% reduction in the PASI score, while only 3 patients in Group-B showed similar results at the end of 12 weeks signifying faster disease clearance with methotrexate. Isotretinoin-related serious adverse effects were fewer and did not warrant treatment discontinuation. Conclusions: Isotretinoin may be an option for alternative therapy in patients who cannot afford acetretin, are intolerant to methotrexate, have achieved its cumulative dose, or in rotational therapy