Subcutaneous Methotrexate vs Oral Treatment in Patients With Psoriasis

The effectiveness of oral vs subcutaneous methotrexate for the treatment of psoriasis in a registry is reported.

More patients with psoriasis who were treated with subcutaneous methotrexate achieved minimal response criteria and possibly better outcomes compared with patients treated with oral doses, according to study findings published in the British Journal of Dermatology.

The study included patients with psoriasis from the German psoriasis registry PsoBest who had started on oral (n=49) or subcutaneous (n=157) methotrexate for the first time and who had possible observation data of 12 months or longer.

At baseline, the mean PASI scores were 20.2 in the oral methotrexate group and 18.6 in the subcutaneous arm. Previous receipt of nonbiologic systemic therapy was noted in 42.9% of patients in the oral methotrexate group and 45.9% of patients in the subcutaneous methotrexate arm.

By week 12, a significantly greater percentage of patients in the subcutaneous methotrexate arm achieved minimal response criteria of PASI 50 (80.9% vs 65.3%; P <.05) and PASI <5 (63.1% vs 44.9%; P <.05). The investigators also observed a trend across PASI 90 and PASI <3 response criteria in terms of better outcomes with subcutaneous methotrexate compared with oral methotrexate after 1 year.

In patients with moderate psoriasis, the mean ± standard deviation (SD) PASI values with oral methotrexate decreased from 14.0±2.9 at baseline to 4.3±4.2 by week 12 and 3.3±3.7 by week 52. In patients with severe psoriasis, the mean±SD PASI values decreased from 28.2±9.5 at baseline to 6.9±7.3 at week 12 in the oral methotrexate arm (p<0.05) and to 6.9±7.8 (6.6±5.9) at week 52.

Common reasons for treatment discontinuation during the 52-week period were for safety (16.3% for oral vs 4.5% for subcutaneous methotrexate) as well as the achievement of skin clearance (2.0% for oral vs 3.8% for subcutaneous methotrexate).

Based on their findings, the investigators of this study suggest “subcutaneous methotrexate rather than oral methotrexate may therefore be considered for the long-term treatment of psoriasis.”

Disclosures: One of the study authors reported an affiliation with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Reich K, Sorbe C, Griese L, Reich JLK, Augustin M. The value of subcutaneous versus oral methotrexate – real-world data from the German psoriasis registry PsoBest. Published online November 21, 2020. Br J Dermatol. doi:10.1111/bjd.19690