Adalimumab–methotrexate combo better than adalimumab monotherapy in psoriasis

In the treatment of patients with psoriasis, the combination of adalimumab plus methotrexate is more beneficial than adalimumab alone, reducing antidrug antibody formation and inducing slightly better response, drug survival, and higher serum trough concentrations, according to a study.

The study assessed the efficacy, safety, pharmacokinetics, and immunogenicity of adalimumab combined with methotrexate (ADL-MTX group) against adalimumab monotherapy (ADL group) in patients with chronic plaque psoriasis. A total of 61 participants were randomly assigned to the ADL-MTX group (n=31) or the ADL group (n=30).

After 1 year of treatment, the ADL-MTX group exhibited better albeit nonsignificant drug survival than the ADL group (74.2 percent vs 58.6 percent; p=0.15).

The combination group also showed a slightly more favourable Psoriasis Area and Severity Index (PASI) 75 response at week 49 (58.1 percent vs 36.7 percent; p=0.13) and higher median serum trough concentrations (6.8 mg/L, interquartile range, 5.5–9.2 vs 5.9 mg/L, interquartile range, 3.5–8.8; p=0.26).

Meanwhile, significantly fewer patients in the ADL-MTX than in the ADL group showed antidrug antibody (22.6 percent vs 60.0 percent; p<0.01). None of the patients in either treatment group developed serious adverse events.

Adalimumab in combination with methotrexate is commonly prescribed for rheumatoid arthritis, given the enhanced treatment effect and reduced antidrug antibody formation compared to adalimumab monotherapy. The current data provide evidence on the long-term treatment effects and pharmacokinetic profile of the combination therapy in the management of psoriasis.