A study to compare the efficacy of methotrexate alone vs. methotrexate plus pioglitazone in the management of plaque-type psoriasis
Keywords:DLQI, Methotrexate, PASI, Pioglitazone, Plaque-type psoriasis
Background: Psoriasis is a common skin condition affecting a huge segment of global population. So far, the treatment has been confined to drugs like methotrexate, cyclosporine and oral retinoids which are highly toxic for long term usage and requires a novel drug that is safer.
Methods: Cases of plaque type psoriasis are divided into two arms and treated with methotrexate monotherapy in group A and methotrexate plus pioglitazone combination therapy in group B. The outcome of the study is analyzed using PASI score and DLQI scoring systems.
Results: Group A and Group B showed significant reduction in the PASI and DLQI scores. Group B was better in terms of efficacy (p<0.05) when compared to Group A. There was no significant difference between the groups in terms of DLQI scoring. Both groups had similar side effect profile.
Conclusions: Pioglitazone which acts by sensitizing the cells to insulin poses no risk of hypoglycemia. It is more specific for the treatment of psoriasis as it targets the keratinocytes. Present study suggests a possible role as an adjuvant in the treatment of psoriasis, and could pave way for low dose methotrexate and thereby reducing the potential side effects.
Menter A, Gottlieb CA, Feldman SR, Voorhees ASV, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2008;58(5):826-50.
Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370:263-71.
Farber EM, Nall L. Epidemiology: natural history and genetics. In: Roenigk Jr HH, Maibach HI, editors. Psoriasis. New York: Dekker; 1998:107-57.
Swanbeck G, Inerot A, Martinsson T, Wahlstrφm J. A population genetic study of psoriasis. Br J Dermatol. 1994;131:32-9.
Kaur I, Kumar B, Sharma VK, Kaur S. Epidemiology of psoriasis in a clinic from North India. Indian J Dermatol Venereol Leprol. 1986;52:208-12.
Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol. 1995;61:202-5.
Kaur I, Handa S, Kumar B. Natural history of psoriasis: a study from the Indian subcontinent. J Dermatol. 1997;24:230-4
Magdalena CO, Anna SP. The possibilities and principles of methotrexate treatment of psoriasis – the updated knowledge. Post epy Dermatol Alergol. 2014;31(6):392-400.
Jeffes EWB, McCullough JL, Pittelkow MR, McCormick A, Almanzor J, Liu G. Methotrexate therapy of psoriasis: differential sensitivity of proliferating lymphoid and epithelial cells to the cytotoxic and growth-inhibitory effects of methotrexate. J Invest Dermatol. 1995;104:183-4.
Kuenzli S, Saurat JH. Peroxisome proliferator-activated receptors in cutaneous biology. Br J Dermatol. 2003;149:229-36.
Lima H, Dogan S, Atakan N, Lima HC, Fallen RS, Mitra A, Morrissey L et al. Psoriasis - Types, Causes and Medication. Published by InTech Janeza Trdine 9, 51000 Rijeka. Croatia . 2013
Boyd AS. Thiazolidinediones in dermatology. Int J Dermatol. 2007;46:557-63.
Friedmann PS, Cooper HL, Healy E. Peroxisome proliferator-activated receptors and their relevance to dermatology. Acta Derm Venereol, 2005;85:194-202.
Ellis CN, Varani J, Fisher GJ. Troglitazone improves psoriasis and normal izes models of proliferative skin disease: ligands for peroxisome proliferators activated receptor-gamma inhibit keratinocytes proliferation. Arch Dermatol. 2000;136(5):609-16.
Demerjian M, Man MQ, Choi EH. Topical treatment with thiazolidinediones, activators of peroxisome proliferator-activated receptor-gamma, normalizes epidermal homeostasis in a murine hyperproliferative disease model. Exp Dermatol. 2006;15(3):154-60.
Pershadsingh HA, Sproul JA, Benjamin E, Finnegan J, Amin NM. Treatment of psoriasis with troglitazone therapy. Arch Dermatol. 1998;134(10):1304-5.
Robertshaw H, Friedmann PS. Pioglitazone: a promising therapy for psoriasis. Br J Dermatol. 2005;152(1):189-91.
Shafiq N, Malhotra S, Pandhi P. Pilot trial: pioglitazone versus placebo in patients with plaque psoriasis (the P6). Int J Dermatol. 2005;44(4):328-33.
Brauchli YB, Jick SS, Curtin F, Meier CR. Association between use of thiazolidinediones or other oral antidiabetics and psoriasis: a population based casecontrol study. J Am Acad Dermatol. 2008;58(3):421-9.
Jermendy G. PPARg agonists-Antidiabetic drugs with a potential role in the treatment of diseases other than diabetes. Diabetes Res Clin Pract. 2007;78S:S29-39.
Lajevardi V, Hallaji Z, Daklan S, Abedini R, Goodarzi A, Abdolreza M. The efficacy of methotrexate plus pioglitazone vs. methotrexate alone in the management of patients with plaque-type psoriasis: a single-blinded randomized controlled trial. Int J Dermatol. 2015;54(1):95-101.