The combination of methotrexate and narrowband ultraviolet B (NBUVB) phototherapy may offer psoriasis patients more rapid clinical improvement of their symptoms than NBUVB phototherapy alone, research suggests.
Inderjeet Kaur and colleagues, from the Postgraduate Institute of Medical Education and Research in Chandigarh, India, say that the rapid clearing of lesions is down to a synergistic effect.
“Both methotrexate and NBUVB have an anti-mitotic and anti-proliferative action on infiltrating T lymphocytes,” they explain. “In addition, both possess significant anti-inflammatory properties.”
The researchers also note that methotrexate reduces scaling and infiltration of lesions, which in turn would enable deeper penetration of NBUVB in the dermis and greater depletion of the dermal T lymphocytes.
“It should thus not be surprising that the combination leads to faster attainment of marked improvement,” the team writes in the Journal of the European Academy of Dermatology and Venereology.
Kaur and colleagues randomly assigned 40 patients with chronic plaque-type psoriasis affecting more than 10% of body surface area to receive either methotrexate/NBUVB phototherapy or placebo/NBUVB phototherapy.
In all, 37 of the patients completed the treatment period of up to 6 months or until a 75% reduction in Psoriasis Area and Severity Index (PASI) was achieved, and 29 completed both the treatment period and a follow-up period of 12 weeks to monitor relapse.
A 75% improvement in PASI score was achieved by 19 patients receiving methotrexate/NBUVB compared with 14 patients receiving placebo/NBUVB.
Moreover, the patients who received methotrexate/NBUVB phototherapy achieved PASI 75 sooner than the other patients, at an average of 7.5 versus 13.5 weeks.
They also achieved PASI 75 at a lower cumulative dose of NBUVB and with fewer phototherapy sessions than the other patients, at an average of 8.86 versus 24.45 J/cm2 and 17 versus 34, respectively.
Just four patients receiving methotrexate/NBUVB and five of those receiving placebo/NBUVB relapsed in the 12 weeks following treatment
Kaur et al conclude: “The combination of methotrexate and NBUVB phototherapy is a useful and an effective treatment for chronic plaque-type psoriasis as it leads to marked improvement in psoriasis lesions in fewer weeks of treatment compared with NBUVB monotherapy.
“In the era of biological, methotrexate/NBUVB combination offers a cheap and clinically beneficial therapeutic option.”