Psoriasis cleared faster and more completely in patients taking adalimumab (Humira, AbbVie) compared with patients taking methotrexate, according to study findings published recently in JAMA Dermatology.
Ari M. Goldminz, MD, from the department of dermatology at Tufts Medical Center in Boston, and colleagues conducted a single-center, randomized, assessor-blind, two-arm clinical trial to compare methotrexate and biologic therapy for psorasis at the genomic and mRNA levels.
They enrolled 30 patients aged 18 to 85 years from an outpatient dermatology center between August 2009 and October 2011 to determine how patients with psoriasis respond to a 16-week course of subcutaneous adalimumab (40 mg every 2 weeks following a loading dose) versus low-dose oral methotrexate sodium (7.5 to 25 mg per week). All patients had chronic plaque-type psoriasis and were randomized in a 1:1 fashion to receive subcutaneous adalimumab or oral methotrexate, according to the study data.
Patients in both the adalimumab and methotrexate groups had a minimum Physician Global Assessment score of 3 and a psoriatic plaque of at least 2 cm. Skin biopsy specimens obtained at baseline and weeks 1, 2, 4, and 16 were evaluated for treatment response.
Adalimumab and methotrexate responses differed by patterns of normalization of chemokine (C-C motif) ligand 20 (CCL20) and interleukin-22 (IL-22) mRNA expression. According to the researchers, this may explain the varied onset and degree of clinical responses by each treatment. It is possible that CCL20 and IL-22 signaling may play a key role in the faster and more complete clinical responses observed with adalimumab compared with methotrexate in the treatment of psoriasis.
“Methotrexate is an immunomodulator with effects on helper T-cell signaling in psoriasis. Similar genomic and immunohistochemical response signatures and levels of mRNA downregulation at study completion among adalimumab and methotrexate responders suggest a disease-driven instead of therapeutic-driven pathway regulation,” the authors concluded.
- Goldminz AM. JAMA Dermatol. Published online May 06, 2015; doi:10.1001/jamadermatol.2015.0452.