[AF] Uso topico de Metotrexato

[Diego Marro]

Bibliografía:

The treatment of psoriasis vulgaris: 1% topical methotrexate gel. 
Int J Dermatol. 2006 Aug;45(8):965-9. 
Eskicirak B, Zemheri E, Cerkezoglu A.  

BACKGROUND: In general, 70% of patients with psoriasis prefer topical
therapy as the treatment of choice. AIM: To evaluate the efficacy and
tolerability of 1% topical methotrexate gel vs. placebo (vaseline ointment)
as treatment for psoriasis. METHODS: Forty patients (20 females and 20
males) with chronic plaque-type psoriasis joined the study. Each patient was
allocated to apply 1% methotrexate gel and placebo topically to their two
target lesions, equal in area and disease severity, twice daily for 8 weeks.
Lesions were scored at baseline and after 2, 4, 6, and 8 weeks of treatment
for erythema, scale, and infiltration. The global improvement and
histopathologic features were also assessed after methotrexate treatment.
RESULTS: At the end of treatment, erythema was cleared totally in 47.5% of
patients treated with methotrexate vs. 7.5% of those treated with placebo,
and infiltration in 22% of patients treated with methotrexate vs. 2.5% of
those treated with placebo (P<0.01). Clinical improvement was almost the
same for the two groups with regard to scale (P<0.5). The global improvement
was 97% for patients treated with methotrexate vs. 60% for those treated
with placebo, and a significant difference was found between the groups
(P<0.01). Histopathologic improvement was achieved in the methotrexate group
(P<0.01). No side-effects were observed. CONCLUSION: The findings of this
study suggest that methotrexate 1% in a hydrophilic gel is well tolerated
and significantly more effective than placebo as a topical medication for
the treatment of psoriasis vulgaris.

Otros:

Syed TA, Hadi SM, Qureshi ZA, Nordstrom CG, Ali SM.Management of psoriasis
vulgaris with methotrexate 0.25% in a hydrophilic gel: a placebo-controlled,
double-blind study.
J Cutan Med Surg. 2001 Jul-Aug;5(4):299-302

BACKGROUND: Methotrexate has been used as one of the first and systemic
therapies for psoriasis. In general, 70% of patients with psoriasis prefer
topical therapy as the treatment of choice. OBJECTIVE: The purpose of this
placebo-controlled double-blind study was to evaluate the clinical efficacy
and tolerability of methotrexate 0.25% incorporated in a hydrophilic gel
(hydroxyethylcellulose 1%) to treat patients afflicted with psoriasis
vulgaris. METHODS: Sixty patients (37M/23F) ranging between 18 and 70 years
of age, with slight to moderate chronic plaque-type psoriasis and PASI
(Psoriasis Area and Severity Index) scores between 5.3 and 17.5 joined the
study. The mean duration of the disease at entry was 9.6 years (range 1-24
years). The diagnosis of psoriasis was established by clinical and
histopathologic methods. Patients were sequentially randomized into two
parallel groups. Each patient was allocated a precoded 100-g tube (active or
placebo) with instructions on how to self-administer the trial medication
topically (without occlusion) to their lesions two times daily for 5
consecutive days per week. The study lasted for 12 weeks with 4 weeks of
active treatment. Patients were examined on a weekly basis and those showing
total clearing or remission of lesions were considered effectively treated.
RESULTS: By the end of the treatment, breaking the code disclosed that
methotrexate 0.25% gel had significantly treated more patients than placebo
(83.3% vs. 6.7%; p < 0.0001), reduced the PASI score to a mean of 2.2, and
cleared more plaques (82.2% vs. 4.3%; p < 0.0001). Laboratory evaluations,
including CBC with differential and platelet count, renal function, liver
chemistry [SGOT (aspartate transaminase) and SGPT (alanine transaminase)],
and serum creatinine, were within the normal limits. The treatment was
well-tolerated by all the patients, with no adverse drug-related symptoms
and no dropouts. The study was followed up for 12 months from the first day
of the treatment; two cured patients had relapsed after 8 months.
CONCLUSION: The findings of this study demonstrate that methotrexate 0.25%
in a hydrophilic gel is well tolerated and significantly more effective than
placebo as a patient-applied topical medication to treat psoriasis vulgaris.


Saludos,

Diego Marro
www.farmaciamarro.com