Etanercept combined with methotrexate for high-need psoriasis


  • Conflicts of interest
    R.J.B. Driessen has received funding from Merck Serono and Wyeth for research, and carried out clinical trials for Wyeth, Schering-Plough, Centocor, Abbott, Merck Serono and Barrier Therapeutics. R.J.B. Driessen has received speaking and consulting fees from Wyeth and Schering Plough and has received reimbursement for attending a symposium from Merck Serono.

  • P.C.M. van de Kerkhof serves as consultant for Schering Plough, Cellgene, Centocor, Allmirall, UCB, Wyeth, Pfizer, Soffinova, Abbott, Actelion, Galderma, Novartis, Janssen Cilag, and Leo Pharma. P.C.M. van de Kerkhof receives research grants from Centocor, Wyeth, Schering Plough, Merck Serono, Abbott, and Philips lighting.

  • E.M.G.J. de Jong serves as consultant for Biogen, Serono, Wyeth, and Abbott. E.M.G.J. de Jong receives research grants from Schering Plough, Abbott, Merck Serono, Wyeth, and Centocor.

Rieke Driessen.


Background  For some high-need psoriatic patients, the efficacy of etanercept monotherapy is insufficient. In these cases it might be indicated to combine etanercept with other conventional treatments.

Objectives  To provide daily practice safety and efficacy data for etanercept and methotrexate combination therapy.

Methods  Data were extracted from an existing database, which contains prospective safety and efficacy data of all patients who were treated with etanercept in clinical practice. A case was defined as a patient using etanercept and methotrexate simultaneously for an indefinite period during follow-up. For all cases, baseline data, Psoriasis Area and Severity Index (PASI) scores, adverse events and laboratory values were investigated. Furthermore, the influence of introduction and discontinuation of methotrexate on these parameters was analysed.

Results  Fourteen patients with simultaneous use of etanercept and methotrexate were selected. In six patients, methotrexate was introduced after etanercept to avoid further psoriasis deterioration, which resulted in an improvement of psoriasis in four of these patients. Eight patients were on methotrexate therapy before start of etanercept. Discontinuation of methotrexate in six of these patients resulted in a decrease in PASI improvement in five patients. Etanercept combined with methotrexate was well tolerated, and only mild adverse events were reported. No clinically significant changes in laboratory parameters occurred.

Conclusions  Results show that combining etanercept with methotrexate is reasonable when efficacy of etanercept monotherapy is insufficient, or when rapid deterioration of psoriasis after abrupt discontinuation of methotrexate is expected. Laboratory values and adverse events were not different from what would have been expected when using methotrexate alone.