Abstract :
Introduction: Psoriasis is a disorder of chronic nature. But the present day systemic therapies for psoriasis
of moderate to severe nature are associated with toxicity and also have a greater level of displeasure in
the patients. Hence the current focus for treatment is with intermittent or combination therapy that helps
to overcome the loss of effectiveness in treatment over time and decrease the side effects as a result of
cumulative toxicities during monotherapy.
Aim: To assess the effectiveness of oral Methotrexate and Etanercept combination therapy in comparison
to Etanercept monotherapy for treatment of moderate to severe plaque type of psoriasis among patients.
Materials and Methods: This was a prospective analytical study conducted in dermatology OPD of
Madras Medical College, a tertiary care centre in south India between August 2015 and July 2016. About
Forty subjects clinically diagnosed with plaque type of psoriasis based upon the clinical history and
morphology of the dermatological lesions were included in this hospital based study depending on inclusion
and exclusion criteria and were randomly allocated into two groups. Group C: Combination therapy with
oral methotrexate and Etanercept and Group M:Monotherapy with Etanercept alone. All the patients were
reviewed every 4 weeks at intervals of 0,4,8 and 12 weeks for complaints and for assessment of clinical
response using PASI scoring and DLQI scoring and other investigations. Data was compiled and analyzed
with the help of Statistical Package for Social Science (SPSS) Version 20.0.
Results: Mean age of the study population was 37.43 10.1 years. Twenty two subjects were males
(55%) and eighteen subjects were females (45%). The subjects who received Group C (Methotrexate and
Etanercept combination therapy) therapy achieved 75% reduction of PASI in comparison to subjects who
received Group M (Etanercept monotherapy) after 8 weeks (30% vs 5%) and after 12 weeks (100% vs
50%). Also Group C showed good response to treatment after 12 weeks in comparison to Group M (85%
vs 50%) and this difference in proportion of treatment response between the two groups was statistically
significant. Subjects who received Group C showed greater decline (77.4% vs 68.7) in DLQI score after 12
weeks in comparison to subjects who received Group M.
Keyword :
Combination therapy, Monotherapy, Etanercept, Methotrexate.