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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Main Authors: Ting-Ting Cheng, Yang Lo
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Dermatologica Sinica
Subjects:
Online Access:https://journals.lww.com/10.4103/ds.DS-D-24-00194
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author Ting-Ting Cheng
Yang Lo
author_facet Ting-Ting Cheng
Yang Lo
author_sort Ting-Ting Cheng
collection DOAJ
description 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.
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publisher Wolters Kluwer Medknow Publications
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series Dermatologica Sinica
spelling doaj-art-7beee538369d4c1c8b891f43330516ef2025-08-20T03:19:57ZengWolters Kluwer Medknow PublicationsDermatologica Sinica1027-81172223-330X2025-04-01432819010.4103/ds.DS-D-24-00194Role of methotrexate in biologics use with psoriasis and psoriatic arthritisTing-Ting ChengYang LoBiologic 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.https://journals.lww.com/10.4103/ds.DS-D-24-00194biologicsmethotrexatepsoriasis
spellingShingle Ting-Ting Cheng
Yang Lo
Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
Dermatologica Sinica
biologics
methotrexate
psoriasis
title Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
title_full Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
title_fullStr Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
title_full_unstemmed Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
title_short Role of methotrexate in biologics use with psoriasis and psoriatic arthritis
title_sort role of methotrexate in biologics use with psoriasis and psoriatic arthritis
topic biologics
methotrexate
psoriasis
url https://journals.lww.com/10.4103/ds.DS-D-24-00194
work_keys_str_mv AT tingtingcheng roleofmethotrexateinbiologicsusewithpsoriasisandpsoriaticarthritis
AT yanglo roleofmethotrexateinbiologicsusewithpsoriasisandpsoriaticarthritis