Value of adding betamethasone pulse therapy to methotrexate in treating patients with psoriasis

Abstract

Background: Psoriasis is an immune-mediated inflammatory disease with unclear pathophysiology. Although diverse medications have been applied, a paucity of knowledge is accessible regarding the use of corticosteroids for psoriasis management. We evaluated the efficacy of corticosteroid pulse therapy in combination with methotrexate versus methotrexate alone for psoriasis treatment. Methods: This cohort study was conducted on 51 hospitalized patients with erythrodermic or pustular psoriasis who were assigned to one of the therapeutic interventions of subcutaneous methotrexate alone (n = 33) or in combination with betamethasone pulse therapy (n = 18). The first group was treated with weekly 15 mg subcutaneous methotrexate for six weeks, and the second group received a similar dose of methotrexate plus 3 mg oral betamethasone weekly. The patients were followed for six months and assessed regarding the disease remission, relapses, the interval between the medication and relapse incidence, and patient satisfaction with the regimens. Results: The studied groups were similar regarding gender (P = 0.296), age(P = 0.561), and the type of cutaneous lesions (P = 0.807). Six months follow-up of the two therapeutic interventions revealed insignificant differences in terms of early response to the treatment (P = 0.993), the incidence (P = 0.142) and frequency of relapses (P = 0.928), and the interval period between the treatment and relapse (P = 0.213). Besides, the patients’ treatment satisfaction did not differ between the groups (P = 0.453). Conclusion: Based on this study, combining methotrexate and low-dose corticosteroid pulse therapy does not lead to better outcomes than methotrexate alone for managing pustular and erythrodermic psoriasis. Further studies are strongly recommended. © Iranian Journal of Dermatology.