Saratov JOURNAL of Medical and Scientific Research

BU Khanty-Mansi Autonomous District— Yugra «Khanty-Mansi clinical skin and venereologic dispensary»

Analysis of the various schemes efficiency of methotrexate use in psoriasis treatment

Summary:

Currently, there has been a steady increase in the incidence of psoriasis, including severe forms. It is extremely important for psoriasis to administrate medicines in time. Methotrexate inhibits the increased proliferation of keratinocytes, inhibits the production of such inflammatory mediators as leukotrienes, TNF-a, collagenase, IL-1, IL-6, but at the same time it increases production of anti-inflammatory IL-10. Objective: to analyze the efficacy of methotrexate in various forms of psoriasis. Material and Methods. Under observation in the period from 2011 to 2016 were 516 patients, including those treated with methotrexate. Methotrexate was assigned according to the scheme: 1st injection 10mg/week, with no adverse effects 20-25 mg/week. All patients received folic acid at a dose of 20-40 mg/day for 5 days starting 3 days after the injection of methotrexate. Evaluation of efficiency was carried out using indices of dermatological status and quality of life. Results. Achievement of clinical remission was observed in 257 (49.7%) in patients; achieving a significant improvement was noted in 32 (6.2%) patients; achieving improvements in 126 (24.4%) patients; no effect 33 (6.4%) patients, and deterioration (further progression of skin lesions) were observed in 68 (13.2%) patients. Conclusion. Methotrexate has a high efficacy in such clinical forms of psoriasis as vulgar (64.9%), inverse (63.9%), exudative (44.7%), and pustular palmar-plantar psoriasis 12.9%.

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The combined application of biological therapy and methotrexate in case of escape phenomenon progressing

Year: 2015, volume 11 Issue: №3 Pages: 405-409
Heading: Dermatovenerology Article type: Short message
Authors: Ponich E.S., Kruglova L.S., Babushkin A.M.
Organization: BU Khanty-Mansi Autonomous District— Yugra «Khanty-Mansi clinical skin and venereologic dispensary»
Summary:

Aim: the study of the efficacy of methotrexate in patients with the "escape effect" during the ustekinumab therapy. Materials and Methods. The results of methotrexate at a dose of 15-20mg/week in treatment of 4 patients receiving biologic and developed "escape effect". Ustekinumab is used as a hypodermic injection at a dose of 45 mg for a body weight of a patient no more than 100 kg, and 90 mg of body weight over 100 kg, at the zero week, the 4th week and then every 12 weeks. Patients control meets the standard management of patients in biological therapy. Results. The study shows that in the case of the resistance progressing when applying preparations of biological therapy, methotrexate is useful at a dose of 15-20mg/week for up to 6 months. The combined use of biologic therapy and methotrexate in the treatment of patients with psoriasis vulgaris, "escape effect" contributes to the marked regression of clinical symptoms and allows to control the process long enough, which is confirmed by the dynamics of the index PASI, BRS and DLQI. The combined method is highly safe, as evidenced by the lack of inhibition of hematopoiesis, the normal level of hepatic transaminases and serum creatinine, which greatly improves patient compliance in this type of therapy. Conclusion. The article presents the data of the combined application of biological medication therapy (ustekinumab) and methotrexate for the treatment of patients with the common form of psoriasis vulgaris. In the case of the development of resistance of biological therapy recommended the appointment of methotrexate. The combined use of methotrexate and biologic therapy in the treatment of patients with psoriasis vulgaris contributes to marked regression of clinical symptoms and allows to control the process for a long time.

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The combined using of ustekinumab and narrow-band phototherapy in treatment of severe psoriasis

Summary:

Aim: research the effectiveness of UVB 311 nm phototherapy in patients with the "escape effect" that developed in the 44th — 56th weeks of the ustekinumab use. Materials and Methods. The examination and treatment of 9 patients with extensive psoriasis vulgaris receiving ustekinumab by hypodermic injection at a dose of 45 mg if body weight of the patient not more than 100 kg, and 90 mg of body weight over than 100 kg, on the zero week, the 4th week and then every 12 weeks. Among them 6 (66,7%) men and 3 (33,3%) women aged from 28 to 65 years. All patients in the 44th — 56th weeks of ustekinumab observed effect of "escape" in connection with which he has been appointed narrowband phototherapy. Results. The combined use of ustekinumab and UVB 311 nm phototherapy in patients with "escape effect" contributes to the marked regression of clinical symptoms and allows you to control the process for long, which is confirmed by the dynamics of the index PASI, BSA and DLQI. Conclusion. In the case of the effect of "escape" in the application of biological therapy drugs (ustekinumab) possible appointment of a narrow-band medium wave phototherapy course 25-30 procedures.

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