Topical Psoriasis Therapies and Unmet Patient Needs: The Importance of Optimizing Methotrexate

Role of Subcutaneous Methotrexate in Patient Care

The types of patients expected to benefit most from subcutaneous MTX include those with moderate to severe psoriasis and those who have experienced dissatisfaction with topical medications or phototherapy. The increased bioavailability of subcutaneous MTX as well as the reduced intensity of gastrointestinal adverse events compared with oral MTX may enable patients to achieve a greater clinical response, and the systemic route of administration may improve treatment adherence and patient satisfaction among those who are dissatisfied with topical treatment regimens. Notably, an additional benefit of optimizing MTX treatment may be the potential to prevent or delay progression to biologic therapies, which may be an important goal of both patients and physicians to prevent higher health care costs.

Another principal role of subcutaneous MTX is as a component of combination therapy with topicals or other systemic therapies for either long-term care or periodic treatment of disease flares. Methotrexate is a frequent component of combination therapies, and subcutaneous administration may be preferable for many patients, particularly those who are already accustomed to injectable therapies (eg, biologic agents) and those who regularly visit a physician who can perform the injections (eg, for regular phototherapy treatments). Interestingly, the coadministration of MTX may be especially valuable in the context of biologic therapies, as concomitant MTX is associated with a reduced incidence of antidrug antibodies and may therefore enhance or prolong responses to biologic agents.

Final Thoughts

Because subcutaneous MTX is infrequently used for the treatment of psoriasis in the United States, increased awareness of its unique advantages may provide new opportunities for patients to tailor treatment regimens to meet individual needs and preferences. Treatment optimization across a broad range of patient characteristics may be critical to improving adherence and satisfaction in psoriasis patients and may be considered a major therapeutic goal.

Acknowledgment

Medical writing assistance was provided by Anna Abt, PhD, of ETHOS Health Communications in Newtown, Pennsylvania, with financial support from LEO Pharma.