Evaluation of the efficacy of methotrexate and cyclosporine therapies on psoriatic nails: a one-blind, randomized study

• Published in: Journal of the European Academy of Dermatology and Venereology 2011-09, Vol.25 (9), p.1080-1084
• Main Authors: Gümüşel, M., Özdemir, M., Mevlitoğlu, İ., Bodur, S.
• Format: Article
• Language: English
• Subjects: cyclosporine; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Humans; methotrexate; Methotrexate - adverse effects; Methotrexate - therapeutic use; Nail Diseases - drug therapy; Nail Diseases - etiology; Nail Diseases - physiopathology; NAPSI; Psoriasis - complications; Psoriasis - drug therapy; Psoriasis - physiopathology; psoriatic nail; Single-Blind Method
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2010.03927.x

Background  Treatment of psoriatic nail is difficult. Objective  The aim of this study was to evaluate and compare the efficacy and safety of methotrexate and cyclosporine in psoriatic nail. Methods  Thirty‐seven psoriatic patients with nail involvement were randomized to treatment with methotrexate (initial dose, 15 mg per week) or cyclosporine (initial dose, 5 mg per kg of bodyweight per day) for 24 weeks. The primary outcome was the Nail Psoriasis Severity Index (NAPSI). The Psoriasis Area and Severity Index (PASI), doctor and patient global score were also measured. The scores were determined by a blinded observer. Results  Seventeen patients completed the study in each group. The mean percentages of reduction of the NAPSI score after methotrexate and cyclosporine treatments were 43.3% and 37.2%, respectively. No significant differences between the treatment groups was found for in the NAPSI, PASI, physician’s and patient’s global score at the end of the study period. The methotrexate group showed a significant improvement in nail matrix scores and the cyclosporine group in nail bed score. Conclusion  Moderate effectiveness on psoriatic nail was found in the two treatment agents and there were no significant differences in efficacy between the groups. A significant improvement was detected in methotrexate group for the nail matrix findings, and in cyclosporine group for the nail bed findings.