title: Assessment of the Therapeutic Aspect of Systemic Non-Biologic Anti-Psoriatic Treatment Modalities Used in Combination with Methotrexate.
abstract: BACKGROUND
  Psoriasis is a common skin disease affecting 1% to 3% of the population worldwide. Combination therapy with traditional systemic anti-psoriatic agents offers a promising method for managing severe or recalcitrant psoriasis.
  
  
  OBJECTIVE
  Lack of documented data regarding the efficacy and safety of combination therapy with methotrexate and other anti-psoriatic drugs in Iranian patients prompted us to design a study to investigate this issue in an Iranian educational hospital.
  
  
  METHODS
  Records of psoriatic patients in Razi Hospital were reviewed retrospectively from October 2008 to March 2012. Forty-six patients who had received methotrexate in combination with other systemic anti-psoriatic agents were included in this study. Response to treatment was evaluated by PASI. Adverse reactions and the type of combination were recorded for all patients.
  
  
  RESULTS
  Methotrexate was most frequently administered in combination with acitretin (n = 21) followed by cyclosporine (n = 11), and NB-UVB and PUVA (n = 6). Combinations were effective in the majority of patients; 46% showed good response (21 patients), 26% showed moderate response (12 patients) and 28% (13 patients) showed poor response who therefore switched to another treatment. The treatments were generally tolerable. Thirty-two patients experienced adverse events although none was severe or required hospitalization. The relative frequencies of adverse reactions were different among groups of patients receiving various therapeutic regimens.
  
  
  CONCLUSIONS
  Methotrexate-combination therapy can offer an effective therapeutic regimen. However, the patients should be monitored for potential adverse effects. More studies are needed to determine the long-term safety and efficacy of these combinations.
authors.affiliation: Department of Dermatology, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Balighi
authors.affiliation: Department of Dermatology, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Ghodsi Seyedeh
authors.initials: GS
authors.lastname: Zahra
authors.affiliation: Department of Dermatology, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Goodarzi
authors.initials: G
authors.lastname: Azadeh
authors.affiliation: Department of Dermatology, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Hejazi
authors.initials: H
authors.lastname: Pardis
authors.affiliation: Department of General Medicine, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Sepehri
authors.initials: S
authors.lastname: Ehsan
authors.affiliation: Department of Dermatology, Tehran University of Medical Sciences (TUMS), Razi Hospital, Tehran, Iran.
authors.forename: Azizpour
authors.initials: A
authors.lastname: Arghavan
keywords: Combination therapy; methotrexate; psoriasis; responsibility; side effects; systemic non-biologic