Methotrexate and cyclosporine seem to work equally well for people with psoriasis, according to new research. The two medications are well-known systemic therapies for those with moderate-to-severe chronic plaque psoriasis. Dr. Menno A. de Rie and colleagues from the University of Amsterdam in the Netherlands published the results in the August 14, 2003 issue of The New England Journal of Medicine.

Drug regimens are frequently changed in people with severe psoriasis to minimize possible side effects. Oftentimes, treatment involves alternating between methotrexate and cyclosporine, yet no studies have compared the effectiveness, side effects, and patients’ quality of life with the two medications.

Rundown of the Participants
A total of 88 patients with moderate-to-severe psoriasis were randomly assigned to treatment for 16 weeks with either methotrexate (44 patients; initial dose, 15 mg per week) or cyclosporine (44 patients; initial dose, 3 mg per kilogram of body weight per day) and were followed for another 36 weeks. Researchers studied the difference between groups in the psoriasis area-and-severity index after 16 weeks of treatment.

Two patients were excluded from the analysis after randomization because they were found to be ineligible, and one patient withdrew his consent. Twelve patients in the methotrexate group had to discontinue treatment because of reversible elevations in liver-enzyme levels, and 1 patient in the cyclosporine group had to do so because of an elevation in the bilirubin level, but all 13 were included in the analysis.

Findings
No significant differences in efficacy were found between methotrexate and cyclosporine for the treatment of moderate-to-severe psoriasis. Patients on either medication experienced similar improvement in their skin lesions, and their quality of life, time to remission, and rate of remission were nearly the same.

Researchers conclude that any differences between the treatments regarding short-term and long-term side effects, costs, and ease of administration (e.g. once daily vs. twice daily treatment) can be used to determine which medication suits a particular patient.