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Low-dose methotrexate – a therapeutical kick in TNF-alpha antagonist treatment for recalcitrant psoriasis vulgaris


  • Funding source: None.
  • Conflict of interest:

    D. Wilsmann-Theis received financial support for performing clinical trials, has served as a consultant for or has received speakers' honoraria and travel scholarships from Abbott GmbH & Co. KG and Pfizer GmbH.

    K. Klingmueller, Th.Bieber, L.Ehler, K.Fronhoffs, and J.Wenzel declare no conflict of interest.


In contrast to the treatment of rheumatoid arthritis, there are few data in psoriasis vulgaris regarding the efficacy of combining tumor necrosis factor (TNF)-alpha inhibitors and methotrexate (MTX). Indeed, combination of MTX with different TNF-alpha inhibitors may enhance the therapeutic effects and reduce side effects because of less dosage of the single agent. The present authors present five cases in which low-dose MTX combined with TNF-alpha inhibitors led to impressive improvement in Psoriasis Area and Severity Index scores. Here, the present authors initiated very low-dose MTX treatment in addition to existing TNF-alpha inhibitor therapy to exhaust current therapy and prevent premature change of the biologic. These observations support the concept of combined treatment in recalcitrant cases of psoriasis, which need a systemically lifelong treatment when both first-line and second-line monotherapies fail to provide sufficient clinical response.

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