Abstract
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.
Highlights
There is paucity of data on efficacy of isotretinoin versus methotrexate in psoriasis patients
Laboratory investigations were performed in all patients, biweekly during the first month and every month during the two months and included complete blood counts, fasting blood sugar, lipid profile, serum creatinine, serum urea, serum glutamine pyruvate transaminase (SGPT), serum glutamine oxalate transaminase (SGOT), alkaline phosphatase, and serum bilirubin
At end of 12 weeks, 5 patients in Group‐A achieved >75% reduction in the PsoriasisArea-and-Severity Index (PASI) score, while only 3 patients in Group‐B showed similar results
Summary
There is paucity of data on efficacy of isotretinoin versus methotrexate in psoriasis patients. Most topical medications (emollients, tars, anthralins, corticosteroids, retinoids (tazarotene), vitamin-D analogues (calcipotriol, calcitriol, tacalcitol, maxacalcitol), topical calcineurin inhibitors (tacrolimus, pimacrolimus), narrowband UVB phototherapy) or systemic therapies (methotrexate, retinoids, cyclosporine A, PUVA (psoralens+UVA), hydroxyurea, biologics), used alone or in combination with topical therapies, control the severity and extent of psoriasis. These therapies are associated with potentially severe toxicities, require extensive monitoring and are expensive [1,4].
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