title: Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial.
abstract: Methotrexate (MTX) treatment for psoriasis is most often administered weekly, because the drug has been considered more hepatotoxic when taken daily. However, some patients may tolerate smaller, more frequent doses better.
  
  
  OBJECTIVE
  To study the efficacy and toxicity of daily vs. weekly MTX.
  
  
  METHODS
  In a randomized controlled trial, 101 patients with generalized plaque psoriasis received oral MTX 2.5 mg daily for weeks, 4 weeks and monthly for a total of 4 months. Changes in PASI scores were classified into three categories: >75% improvement was considered significant; 25-75% moderate; and <25% poor.
  
  
  RESULTS
  Sixty Group 1 patients and 81 Group 2 patients showed a significant response (P-value 0.001); 19 patients in Group 1 and 14 in Group 2 responded moderately; 22 patients in Group 1 and six patients from Group 2 responded poorly. Forty-five patients in Group 1 and 33 in Group 2 developed transient increases in liver enzymes (P-value 0.11). Nausea, headache, fatigue, and gastrointestinal upset were noted in four Group 1 patients and 30 Group 2 patients (P-value 0.0001).
  
  
  CONCLUSIONS
  Nausea, vomiting, headache, and fatigue were significantly less common side effects in our patients who received MTX daily, but liver enzyme abnormalities were less common, and clinical efficacy was greater in the patients who received MTX weekly.
authors.affiliation: Department of Dermatology, Jondishapour University of Medical Sciences, Ahvaz, Iran. radmanesh_m@yahoo.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Radmanesh
authors.forename: Behnam
authors.initials: B
authors.lastname: Rafiei
authors.forename: Zahra-Beigum
authors.initials: ZB
authors.lastname: Moosavi
authors.forename: Niloofar
authors.initials: N
authors.lastname: Sina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D003404:Creatinine; D008727:Methotrexate