A retrospective analysis of combination methotrexate-cyclosporine therapy in moderate-severe psoriasis

Background: Methotrexate-cyclosprine combination therapy has traditionally been discouraged in the treatment of moderate-severe psoriasis. However, recent reports indicate that the two may be used in combination in psoriasis. Aim: The retrospective study was undertaken to study the adverse effects and efficacy of the combination in Indian patients of psoriasis. Methods: The records of all patients who received combination therapy between 2005 and 2010 were extracted. Demographic details, disease profile, presence of coexistent arthropathy, prior therapy, duration of combination therapy, body surface area involvement, Psoriasis Area and Severity Index (PASI), and adverse effects were recorded. Descriptive statistics were used to analyze the data. Results: Eighteen patients received combination therapy during the study period. Fourteen patients received short-term combination therapy and four patients received long-term combination therapy. Twelve patients in the first group and all patients of the second group achieved the primary end point of PASI by 50% from baseline (PASI 50). Nine patients in the first group and all patients in the second group suffered from significant adverse effects; they were however reversible. Conclusion: Methotrexate-cyclosporine combination therapy can be used with adequate monitoring in the treatment of moderate-severe psoriasis. Adverse effects seen are usually reversible with reduction in dose and cessation of therapy. Adverse effects related to cyclosporine are a common problem.