Methotrexate & Adalimumab for Psoriasis: No Added Benefit
New research reveals combining methotrexate with adalimumab for plaque psoriasis doesn’t boost treatment outcomes. Study results show no added benefit to drug survival or effectiveness compared to adalimumab alone. The cohort study, based in the UK, analyzed data from over 1,700 patients, revealing similar adverse event rates between the two groups, challenging the efficacy of the combination therapy. The study, published in JAMA Dermatology and covered by News Directory 3, highlights key findings on drug survival, PASI 75 achievement, and antibody levels, suggesting monotherapy could be a viable option. Curious about future research on treatment strategies for plaque psoriasis? Discover what’s next …
Methotrexate with Adalimumab Not Effective for Psoriasis Treatment
Updated June 04, 2025
A recent study conducted in the United Kingdom suggests that combining methotrexate with adalimumab dose not enhance treatment outcomes for adults suffering from plaque psoriasis. The research, which focused on drug survival and effectiveness, challenges the notion that the combination therapy offers a notable advantage over adalimumab alone in treating this common skin condition.
The cohort study, which emulated a target trial, analyzed data from 1,784 patients with moderate to severe plaque psoriasis.These patients were part of the British Association of Dermatologists Biologic and Immunomodulators Register from 2007 to 2021. Researchers, led by zenas Yiu, PhD, from the University of Manchester, divided participants into two groups: one receiving adalimumab monotherapy (1,553 patients) and another receiving adalimumab plus methotrexate (231 patients).
The primary focus was to determine the difference in adalimumab drug survival at one year between the two groups. Secondary outcomes included the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75), the occurrence of adverse events, and the levels of adalimumab drug and antidrug antibodies.
the findings, published in JAMA Dermatology, indicated that drug survival rates were nearly identical between the two treatment approaches. At one year,survival rates were 79.1% for the combination therapy group and 78.1% for the adalimumab-only group. Similar results were observed at three years, with rates of 59.3% and 57.2%, respectively.
PASI 75 achievement rates also showed minimal difference. At one year,52% of patients in the monotherapy group and 49.4% in the combination therapy group reached PASI 75. At three years, the rates were 32.4% and 37.2%,respectively.
Serious adverse event rates were comparable, with 7.8% in the combination group and 5.9% in the monotherapy group at one year.
Interestingly, the combination therapy group exhibited a lower antidrug antibody level (meen difference, −123.7 AU/mL) and a numerically higher estimated drug concentration level (1.3 mcg/mL) compared to the monotherapy group.
“This target trial emulation cohort study did not find evidence that adding methotrexate to adalimumab was beneficial for treating plaque psoriasis,” the study authors wrote.
The authors suggested that future research should concentrate on higher doses of methotrexate or explore its combination with other biologics for plaque psoriasis or with adalimumab for different inflammatory skin conditions.
What’s next
Further studies are needed to explore choice treatment strategies for plaque psoriasis, potentially focusing on personalized approaches and different combinations of systemic medications.