Effıcacy of Subcutaneous Methotrexate in Symmetrıcal Psorıatıc Plauqes

Abstract

Abstract

Introduction: Psoriasis is a chronic and recurrent skindisease characterized by inflammation and hyperproliferation, the etiology of which is unknown. Generally; In caseswhere more than 10% of body surface area is affected or not responding sufficiently with local treatments, systemic treatment agents are applied. Methotrexate is the most com-monly used systemic agent in the treatment of psoriasis.

Aim: In our study, we aimed to evaluate the effectiveness of methotrexate applied SK in the symmetrically lo-cated psoriasis lesions, the response of the applied bodyside and under the applied lesion to the symmetry side andlesion.

Materials and Methods: 22 psoriasis patients (15 E,7 K) who presented with symmetric plaque type psoriasislesions were included in the study. Patients received subcutaneous methotrexate treatment at a dose of 20 mg / weekfor a total of 8 weeks. The applied side of the body and theother side; The ’psoriasis field intensity score (PASI) before and after treatment was calculated and recorded.

Results: When PASI scores were examined, it was10.98 pretreatment (PASI 1), 2.36 after the treatment andthe body side (PASI 2) at the symmetry of the body (PASI2) before the treatment and 10.66 after the treatment, and 2.68 after the treatment. There was a statistically signifi-cant decrease in PASI score before the treatment in bothgroups (p <0.0001). The mean decrease in PASI 1 was71.79% and PASI 2 was 66.90%. There was a statistically  significant difference between PASI scores before and after treatment (p <0.0001).

Conclusion: In conclusion, in the presence of systemictreatment resistant plaques, we believe that application ofSC methotrexate may be one of the primary steps in the treatment, and that application of the application under resistant lesions will increase the response to treatment and further studies should be performed in this respect.

Keywords

• Psoriasis,subcutaneous injection,methotrexate

Simetrik Psoriatik Plaklarda Subkutan Metotrexatın Etkinliği

Öz

Öz

Giriş: Psoriazis etiyolojisi tam olarak bilinmeyen, inflamasyon ve hiperproliferasyon ile karakterize kronik ve tekrarlayıcı bir deri hastalığıdır. Genel olarak; lokal tedaviler ile yeterli yanıt alınamayan veya vücut yüzey alanının %10’undan fazlasının etkilendiği durumlarda, sistemik tedavi ajanları uygulanmaktadır. Metotreksat psoriazis tedavisinde en yaygın kullanılan sistemik ajandır.

Amaç: Çalışmamızda simetrik yerleşimli psoriazis lezyonlarında SK uygulanan me-totreksat etkinliğini, uygulama yapılan vücut tarafının ve altına uygulama yapılan lezyonun simetriğindeki tarafa ve lezyona göre yanıtını değerlendirmeği amaçladık.

Materyal-Metod: Çalışmaya simetrik yerleşimli plak tipi psoriazis lezyonları ile başvuran 22 psoriazis hastası (15 E,7 K) dahil edildi. Hastalara 20 mg/hafta dozunda, toplam 8 hafta lezyon altına subkutan metotreksat tedavisi uygulandı. Uygulama yapılan vücut tarafının ve diğer tarafın; tedavi öncesinde ve sonrasındaki ‘psoriazis alan şiddet indeksi’ (PASİ) skoru hesaplandı ve kaydedildi.

Sonuçlar: PASİ skorları incelendiğinde enjeksiyon yapılan vücut tarafında (PASİ1) tedavi öncesi 10.98, tedavi sonrası 2.36 ve simetriğindeki vücut tarafında (PASİ 2)tedavi öncesi 10.66, tedavi sonrası 2.68 idi. Her iki grupta tedavi öncesi PASİ skoru yüksek iken tedavi sonrası istatistiksel olarak anlamlı bulunan azalma vardı (p<0.0001). PASİ1‘de ortalama azalma %71.79, PASİ 2‘de %66.90 olarak hesaplandı. Tedavi öncesi ve sonrası PASİ skorları açısından enjeksiyon yapılan vücut tarafı ve simetriğindeki tarafarasında istatistiksel olarak anlamlı fark saptandı (p<0.0001).

Sonuç: Sonuç olarak sistemik tedavilere dirençli plakların varlığında, SK metotreksat uygulamasının tedavide öncelikli basamaklardan biri olabileceğini, uygulamanın dirençli lezyonların altına yapılmasının tedaviye yanıtı arttıracağını ve bu açıdan daha ileri çalışmalar yapılması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Psoriasis,subcutan injeksiyon,metotreksat

Kaynakça

1. Kaynaklar 1.Choi J, Koo JY. Quality of life issues in psoriasis. J Am Acad Dermatol 2003;49(Suppl 2):57-61. 2.Nijsten T, Margolis DJ, Feldman SR, Rolstad T, Stern RS. Traditional systemic treatments have not fully met the needs of psoriasis patients: results from a national survey. J Am Acad Dermatol 2005;52:434-44 3.Yamauchi PS, Rizk D, Kormeili T, Patnaik R, Lowe NJ. Cur-rent systemic therapies for psoriasis: where are we now? J AmAcad Dermatol 2003;49(Suppl 2):66-77. 4.Dutz JP, Ho VC. Immunosuppressive agents in dermatology.An update. Dermatol Clin 1998;16:235-51. 5.Griffiths CEM, Camp RDR, Barker JNWN. Psoriasis. In: TonyBurns, Stephen Breathnach, Neil Cox, Christopher Griffiths,(eds). Rook’s Textbook of Dermatology. Vol 2. 7th edition. Oxford: Blackwell Science Limited 2004:35.1-35.6. 6.Zackheim HS. Subcutaneous administration of methotrexate.J Am Acad Dermatol 1992;26(6):1008. 7.Warren RB, Griffiths CE. Systemic therapies for psoriasis: methotrexate, retinoids, and cyclosporine. Clin Dermatol2008;26(5):438-47. 8.Arthur V, Jubb R, Homer D. A study of parenteral use of methotrexate in rheumatic conditions. J Clin Nurs 2002;11:256–63. 9.Braun J, Kästner P, Flaxenberg P, et al; MC-MTX.6/RH StudyGroup. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a sixmonth, multicenter, randomized, double-blind, controlled, phase IV trial. Arthritis Rheum 2008;58(1):73-81. 10.Osman A, Mulherin D. Is parenteral methotrexate worth trying?Ann Rheum Dis 2001;60:432. 11.Heydendael VM, Spuls PI, Opmeer BC, de Borgie CA, Reitsma JB, Goldschmidt WF, et al. Methotrexate versus cyclosporine in moderatetosevere chronic plaque psoriasis. N Engl JMed 2003;349:658-65.12.Freeman-Narrod M, Gerstley BJ, Engstrom PF. Comparisonof serum concentrations of methotrexate after various routesof administration. Cancer 1975;36:1619–24. 13.Kremer JM, Lee JK. The safety and efficacy of the use of methotrexate in long term therapy for rheumatoid arthritis.Arthritis Rheum 1986;29:822–31. 14.Bingham SJ, Buch H, Lindsay S, Pollard A, White J, EmeryP. Parenteral methotrexate should be given before biologicaltherapy. Rheumatology 2003;42:1009–10. 15.Hamilton RA, Kremer JM. Why intramuscular methotrexatemay be more efficacious than oral dosing in patients with rheumatoid arthritis. Br J Rheumatol 1997;36:86–90. 16.Wegrzyn J, Adeleine P, Miossec P. Better efficacy of methotre-xate given by intramuscular injection than orally in patients withrheumatoid arthritis. Ann Rheum Dis 2004;63(10):1232-4. 17.Hoekstra M, Haagsma C, Neef C, Proost J, Knuif A, van deLaar M. Bioavailability of higher dose methotrexate compa-ring oral and subcutaneous administration in patients withrheumatoid arthritis. J Rheumatol 2004;31(4):645-8. 18.Arthur AB, Klinkhoff AV, Teufel A. Safety of selfinjection ofgold and methotrexate. J Rheumatol 1999 Feb;26(2):302-5. 19.Roenigk HH, Auerbach R, Maibach HI et al. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol 1988;19:145–6. 20.Flytstrom I, Stenberg B, Svensson A. Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. Arandomized controlled trial. Br J Dermatol 2008;158:116-21. 21.Bigby M. A randomized controlled trial of methotrexate andcyclosporine in the treatment of psoriasis. Arch Dermatol2004;140(3):347-9. 22.Saurat JH, Stingl G, Dubertret L, Papp K, Langley RG, Ortonne JP,et al. Efficacy and safety results from the randomized controlled com-parative study of adalimumab vs. methotrexate vs. placebo in patientswith psoriasis (CHAMPION). Br J Dermatol 2008;158:558-66. 23.Koo J, Lebwohl M. Duration of remission of psoriasis thera-pies. J Am Acad Dermatol. 1999;41(1):51-9.