PMID- 27168193
OWN - NLM
STAT- MEDLINE
DCOM- 20170706
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 5
DP  - 2016
TI  - Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published 
      Trials.
PG  - e0153740
LID - 10.1371/journal.pone.0153740 [doi]
LID - e0153740
AB  - BACKGROUND: 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.
FAU - West, Jonathan
AU  - West J
AD  - University of Dundee, College of Medicine, Dentistry, and Nursing, Dundee, 
      Scotland.
FAU - Ogston, Simon
AU  - Ogston S
AD  - University of Dundee, College of Medicine, Dentistry, and Nursing, Dundee, 
      Scotland.
FAU - Foerster, John
AU  - Foerster J
AD  - University of Dundee, College of Medicine, Dentistry, and Nursing, Dundee, 
      Scotland.
AD  - Department of Dermatology and Photobiology, NHS Tayside, Dundee, Scotland.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20160511
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Dermatologic Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
EIN - PLoS One. 2016;11(7):e0158928. PMID: 27380015
MH  - Arthritis, Rheumatoid/drug therapy
MH  - Dermatologic Agents/*administration & dosage/adverse effects
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage/adverse effects
MH  - Methotrexate/*administration & dosage/adverse effects
MH  - Nausea/chemically induced/diagnosis
MH  - Opportunistic Infections/chemically induced/diagnosis
MH  - Oral Ulcer/chemically induced/diagnosis
MH  - Patient Safety
MH  - Psoriasis/*drug therapy
MH  - Risk
MH  - Treatment Outcome
PMC - PMC4864230
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2016/05/12 06:00
MHDA- 2017/07/07 06:00
PMCR- 2016/05/11
CRDT- 2016/05/12 06:00
PHST- 2015/04/20 00:00 [received]
PHST- 2016/04/04 00:00 [accepted]
PHST- 2016/05/12 06:00 [entrez]
PHST- 2016/05/12 06:00 [pubmed]
PHST- 2017/07/07 06:00 [medline]
PHST- 2016/05/11 00:00 [pmc-release]
AID - PONE-D-15-17092 [pii]
AID - 10.1371/journal.pone.0153740 [doi]
PST - epublish
SO  - PLoS One. 2016 May 11;11(5):e0153740. doi: 10.1371/journal.pone.0153740. 
      eCollection 2016.