Role of methotrexate in biologics use with psoriasis and psoriatic arthritis

Biologic agents have significantly improved treatment outcomes for psoriasis and psoriatic arthritis (PsA). However, their long-term effectiveness can decline due to the formation of anti-drug antibodies. The off-label addition of methotrexate (MTX) to biologics offers benefits through synergistic a...

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Bibliographic Details
Main Authors: Ting-Ting Cheng, Yang Lo
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Dermatologica Sinica
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Online Access:https://journals.lww.com/10.4103/ds.DS-D-24-00194
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Summary:Biologic agents have significantly improved treatment outcomes for psoriasis and psoriatic arthritis (PsA). However, their long-term effectiveness can decline due to the formation of anti-drug antibodies. The off-label addition of methotrexate (MTX) to biologics offers benefits through synergistic antipsoriatic effects and reduced immunogenicity, primarily by increasing extracellular adenosine levels and inducing the anergy state of T and B cells. In patients with psoriasis, the addition of MTX has been shown to improve the efficacy of tumor necrosis factor-α inhibitors, although controlled data on its combination with interleukin (IL)-17 or IL-23 inhibitors are limited. In PsA, however, combination therapy with MTX provides little to no additional efficacy compared to biologic monotherapy.
ISSN:1027-8117
2223-330X