Evaluating the Relative Effectiveness of Methotrexate and Acitretin in Chronic Plaque Psoriasis Treatment

Abstract

Background: Chronic plaque psoriasis is a prevalent autoimmune skin disorder characterized by persistent red, scaly plaques. Methotrexate and acitretin are established systemic therapies, but their comparative efficacy in treating chronic plaque psoriasis needs further research. Objective: To compare the efficacy of methotrexate and acitretin in chronic plaque psoriasis treatment. Study Design: Randomized Controlled Trial. Settings: This study was conducted at DHQ Hospital, Muzaffargarh Pakistan. Duration: December 2022 to May 2023. Methods: Total 155 patients diagnosed with Chronic Plaque Psoriasis, aged 18 to 55 years, are recruited from the OPD of hospital. Inclusion criteria comprise a confirmed diagnosis of chronic plaque psoriasis and no prior exposure to methotrexate or acitretin within the last six months. Patients with previous intolerance or allergic reactions to methotrexate or acitretin, presence of severe hepatic impairment or chronic liver disease and known pregnancy or lactating mothers were excluded. Participants were randomized into two groups using computer-generated random numbers. Group A receives methotrexate at a dose once a week for 12 weeks as a tablet at a dosage of 0.3-0.5 mg/kg and Group B is treated with Acitretin in which patients were given a capsule at a dosage of 0.4 mg/kg daily for duration of 12 weeks. Statistical analysis is performed using SPSS version 23. Results: The study involved 150 patients with a mean age of 52.33± 16.55. Gender distribution indicated that 47(31.33%) were male, and 103(68.66%) were female. The baseline PASI scores for the methotrexate and acitretin groups were 14.12±3.21 and 14.79±1.08, respectively. At the 3-month, the PASI scores were 7.92±2.07 for methotrexate and 8.14±1.03 for acitretin. The mean reduction in PASI scores was 54.12±9.22 for methotrexate and 47.31 ± 11.31 for Acitretin, with a significant difference favoring Methotrexate (p =0.031*). Of the total participants, 68.66% demonstrated efficacy, with 78.66% in the methotrexate group and 58.66% in the acitretin group, indicating a significant difference (p < 0.005*). Conversely, 31.33% showed no efficacy, with 21.33% in the methotrexate group and 41.33% in the acitretin group. Conclusion: In conclusion, the frequency of effectiveness was significantly higher with methotrexate (78.66% vs. 58.66%) p=<0.005) as compared to acitretin in treating chronic plaque psoriasis.