Management Of Psoriasis With Systemic Nonbiologic Therapies

Publication Date: March 1, 2020
Last Updated: November 1, 2023

Recommendations

Methotrexate in psoriasis therapy

Methotrexate is recommended for the treatment of moderate to severe psoriasis in adults. (A)
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Methotrexate is less effective than adalimumab and infliximab for cutaneous psoriasis. (A)
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Methotrexate is efficacious for treatment of psoriatic arthritis (peripheral arthritis, but not for axial involvement). In psoriatic arthritis, the efficacy of methotrexate is lower than TNF-inhibitors. (B)
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Recommended methotrexate dosage typically ranges from 7.5 to 25 mg weekly. The dose can be given as a single dose or in 3 doses over 24 hours. (B)
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Methotrexate can be administered orally or subcutaneously. (A)
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A test dose should be considered, especially in patients with impaired kidney function. (B)
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Administration of folic acid or folinic acid is recommended to reduce the incidence of GI and hepatic adverse effects. Large folic acid and folinic acid doses may reduce the efficacy of methotrexate. (A)
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Combination therapy with methotrexate and NB-UVB phototherapy can be considered for adult patients with generalized plaque psoriasis to enhance efficacy and lower cumulative doses of both treatments. (B)
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Overview

Title

Management Of Psoriasis With Systemic Nonbiologic Therapies

Authoring Organizations

American Academy of Dermatology

National Psoriasis Foundation