The role of methotrexate TDM in psoriasis treatment

Czech version

Authors: J. Chládek
Authors‘ workplace: Ústav farmakologie, LF UK v Hradci Králové
Published in: Kardiol Rev Int Med 2015, 17(1): 92-95
Category: Internal Medicine

Overview

Methotrexate (MTX) is a conventional immunosuppressive drug of first choice in oral therapy of moderate‑ to‑ severe plaque psoriasis. Its use is comfortable and cost effective. The therapy improves the skin status according to the PASI score (psoriasis area and severity index) by 50% or more in up to 75% of patients. However, a high inter‑ individual variability in pharmacokinetics is one of the major factors responsible for either insufficient efficacy of the therapy or its premature discontinuation due to adverse effects of MTX. The review article critically evaluates the possible benefits of therapeutic drug monitoring (TDM) of MTX as a tool for personalized pharmacotherapy of psoriasis. Prospective clinical studies unraveled a relationship between the pharmacokinetics and the therapeutic effect of MTX. Recommendations on how to perform TDM were worked out and verified, which helped to improve the outcomes of the initial treatment phase (remission induction). Besides the individualization of MTX dosing, supplementation with folic acid was individually tailored only to patients with a proven folate deficit.

Keywords:
methotrexate – psoriasis – therapeutic drug monitoring

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