Methotrexate boosts UV therapy for psoriasis

NEW YORK (Reuters Health) - Pretreatment with the drug methotrexate reduces the number of ultraviolet light therapy sessions patients require to clear up psoriasis, according to the results of a small clinical trial.

Dr. Pravit Asawanonda and Dr. Yaowalak Nateetongrungsak from Chulalongkorn University in Bangkok evaluated the effectiveness of methotrexate in combination with narrowband UVB light therapy in 24 patients with psoriasis.

Eleven of them were assigned to receive methotrexate, while the others received placebo pills, for 3 weeks before starting UVB therapy.

UVB therapy with or without methotrexate pretreatment reduced psoriasis severity Index scores, the researchers report in the Journal of the American Academy of Dermatology, but the reductions were greater in the methotrexate group.

Ten of the 11 patients who received methotrexate plus UVB achieved clearance of psoriasis lesions, the results indicate, compared with 5 of 13 patients treated with UVB alone.

The average time to clear was 4 weeks in the methotrexate group, but the average time in the UVB-only group couldn't be estimated because more than half of them still had lesions at the end of the 24-week study.

Patients in the methotrexate group also required a lower cumulative dose of UVB exposure than did those in the UVB-only group, the report indicates.

Quality of life scores and adverse events did not differ between the two groups.

"We have demonstrated that the combination of a 3-week course of methotrexate followed by narrowband UVB clears more patients with psoriasis (i.e., 90.9% versus 38.5%) and in significantly fewer treatments than when narrowband UVB is used alone," the investigators write.

"We propose that the combination of methotrexate and narrowband UVB phototherapy is a useful and relatively safe treatment for plaque-type psoriasis," they conclude. "This combination could be especially useful in developing countries,"

SOURCE: Journal of the American Academy of Dermatology, June 2006.