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dc.contributor.authorWest, Jonathan
dc.contributor.authorOgston, Simon
dc.contributor.authorFoerster, John
dc.identifier.citationWest , J , Ogston , S & Foerster , J 2016 , ' Safety and efficacy of methotrexate in psoriasis : a meta-analysis of published trials ' , PLoS ONE , vol. 11 , no. 5 , e0153740 .
dc.identifier.otherPURE: 260534331
dc.identifier.otherPURE UUID: 40214dc4-a5c4-466f-96a5-d187e4f1c59e
dc.identifier.otherPubMed: 27168193
dc.identifier.otherPubMedCentral: PMC4864230
dc.identifier.otherScopus: 84969933365
dc.description.abstractBACKGROUND: Methotrexate (MTX) has been used to treat psoriasis for over half a century. Even so, clinical data characterising its efficacy and safety are sparse. OBJECTIVE: In order to enhance the available evidence, we conducted two meta-analyses, one for efficacy and one for safety outcomes, respectively, according to PRISMA checklist. (Data sources, study criteria, and study synthesis methods are detailed in Methods). RESULTS: In terms of efficacy, only eleven studies met criteria for study design and passed a Cochrane risk of bias analysis. Based on this limited dataset, 45.2% [95% confidence interval 34.1-60.0] of patients achieve PASI75 at primary endpoint (12 or 16 weeks, respectively, n = 705 patients across all studies), compared to a calculated PASI75 of 4.4 [3.5-5.6] for placebo, yielding a relative risk of 10.2 [95% C.I. 7.1-14.7]. For safety outcomes, we extended the meta-analysis to include studies employing the same dose range of MTX for other chronic inflammatory conditions, e.g. rheumatoid arthritis, in order not to maximise capture of relevant safety data. Based on 2763 patient safety years, adverse events (AEs) were found treatment limiting in 6.9 ± 1.4% (mean ± s.e.) of patients treated for six months, with an adverse effect profile largely in line with that encountered in clinical practice. Finally, in order to facilitate prospective clinical audit and to help generate long-term treatment outcomes under real world conditions, we also developed an easy to use documentation form to be completed by patients without requirement for additional staff time. LIMITATIONS: Meta-analyses for efficacy and safety, respectively, employed non-identical selection criteria. CONCLUSIONS: These meta-analyses summarise currently available evidence on MTX in psoriasis and should be of use to gauge whether local results broadly fall within outcomes.
dc.relation.ispartofPLoS ONEen
dc.rights© 2016 West et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en
dc.subjectArthritis, Rheumatoid/drug therapyen
dc.subjectDermatologic Agents/administration & dosageen
dc.subjectImmunosuppressive Agents/administration & dosageen
dc.subjectMethotrexate/administration & dosageen
dc.subjectNausea/chemically induceden
dc.subjectRL Dermatologyen
dc.subjectRM Therapeutics. Pharmacologyen
dc.titleSafety and efficacy of methotrexate in psoriasis : a meta-analysis of published trialsen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.description.statusPeer revieweden

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