Abstract
Background and Objectives: Methotrexate is widely prescribed for the treatment of moderate-to-severe psoriasis. As drug survival encompasses efficacy, safety, and treatment satisfaction, such studies provide insights into successful drug treatments in the real-life scenario. The objective was to define methotrexate drug survival and reasons for discontinuation, along with factors associated with drug survival, in a cohort of adult patients with moderate-to-severe plaque psoriasis. Materials and Methods: Data on methotrexate treatment were extracted from our institutional registry. Drug survival was estimated by Kaplan–Meier analysis, and predictors of drug survival were analyzed by Cox proportional hazards regression. Results: We included 133 patients treated with methotrexate. Due to significant effects of the year of treatment initiation, drug survival analysis was performed for 117 patients who started methotrexate in 2010 or later. Median methotrexate drug survival was 11.0 months. Overall, 89% of patients discontinued treatment, with over half of these (51%) due to lack of efficacy. Significantly longer drug survival was seen for patients who discontinued treatment due to lack of efficacy versus drug safety (p = 0.049); when stratified by sex, this remained significant only for women (p = 0.002). The patient ABCC2 rs717620 genotype was significantly associated with drug survival in both univariate log-rank and multivariate Cox regression analyses, with variant T allele associated with longer drug survival (hazard ratio, 0.606; 95% confidence interval, 0.380–0.967; p = 0.036). Conclusions: We have identified the novel association of patient ABCC2 rs717620 genotype with methotrexate drug survival. This pharmacogenetic marker might thus help in the management of psoriasis patients in daily practice.
Highlights
Methotrexate is an immunosuppressive and antiproliferative agent with a wellestablished place in the treatment of patients with psoriasis [1,2]
We identified a significant impact of the year of methotrexate introduction on drug survival, and we divided the patients into only two groups according to the entry of ustekinumab onto the market, a pronounced reduction in the median methotrexate drug survival was observed
This study describes methotrexate treatment in a daily practice cohort of patients with moderate-to-severe psoriasis
Summary
Methotrexate is an immunosuppressive and antiproliferative agent with a wellestablished place in the treatment of patients with psoriasis [1,2] It is the most commonly used conventional systemic drug and remains a first-line treatment for patients with moderate-to-severe psoriasis [2,3,4]. Data from short-duration clinical trials performed with pre-selected patients need to be supported by data on methotrexate use in daily practice, e.g., from drug survival studies [6,7]. These studies are considered as real-life measures of treatment success, as they reflect drug efficacy and safety and indicate patient and physician preference [8,9].
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