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Methotrexate — More isn’t Better

Monday, November 2nd, 2009

According a recent study done by researchers in Berlin, if a patient taking methotrexate (MTX) for psoriasis does not show significant improvement in after 12 weeks, then increasing dosage will most likely not improve their condition.  According to this report, the maximum dosage recommended for anyone taking MTX for psoriasis is 20 mg per week.  This weekly dose should be split up into at least two administrations to minimize immediate side effects such as nausea.

How does methotrexate work?

MTX hinders cell reproduction by blocking DNA synthesis (this is a vital part in in the cellular reproductive process).  It is especially adept at blocking hyper-proliferating cells such as those affected by psoriasis or cancer.  It is also used as an immunosuppressant to battle conditions that affect the immune system such as arthritis, Crohn’s disease or psoriasis.

How is methotrexate administered?

MTX can be administered either orally or via injection.  Taking it in pill form is most common when it is used to treat psoriasis.

Why are doctors hesitant to prescribe more than 20 mg of methotrexate per week?

MTX is also used to treat cancer, and you have probably heard of the some of the harsh side-effects that cancer treatments tend to have.   In smaller doses, which are appropriate for psoriasis patients, it still can cause some serious side effects, including long-term liver damage and drops in white blood cell counts.  The main benefit of methotrexate — that is hinders cell re-production — can also wreak havoc on other parts of the body.

What are some of the brands names used to market methotrexate?

MTX is marketed under the brand names Trexall and Rheumatrex.

A syringe filling with methotrexate solution (courtesy of Flickr):
methotrexate syringe injection

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What is Hydroxyurea?

Tuesday, October 20th, 2009

Hydroxyurea is considered a good alternative for those who are physically unable to take methotrexate.  Like methotrexate, hydroxyurea inhibits DNA synthesis (cell reproduction) thus limiting the effects of psoriasis and other hyperprolific cells such as cancer.

Hydroxyurea is considered “second” to methotrexate for the purposes of treating psoriasis because it’s generally not as effective while it still poses many severe health risks.

It should be noted at the same time that Hydroxyurea occasionally suppresses psoriasis outbreaks where methotrexate fails.  Thus, it is the case for all psoriasis cases that different treatments will work for different people depending on their genetic make-up and daily habits (including diet and overall health).

Hydroxyurea is marketed under the brand names “Hydrea” and “Droxia.”

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How Does Methotrexate Work?

Monday, October 12th, 2009

Methotrexate (or ‘MTX’ for short) keeps unhealthy cells from reproducing too quickly.  Psoriasis and cancer are two examples of unhealthy cell proliferation, which MTX is designed to prevent. 

The discovery of MTX led to what is now modern chemotherapy.  As you might imagine, you don’t need as much of this drug to fight off psoriasis as you might need for cancer.

MTX keeps the enzyme dihydrofolate reductase from forming another compound called “tetrahydrofolate” which is needed for cell reproduction. It does this by posing as a folic acid molecule, thus binding to dihydrofolate reductase before real folic acid gets the chance.  MTX is much more (1000 times more) prone to bind dihydrofolate reductase than folic acid, and thus is an effective antifolate (something that keeps folic acid from doing its job). When this process is allowed to proceed normally it is also called “metobolizing,” so methotrexate is also called an “antimetabolite.”

The risks of taking MTX to treat psoriasis are justified when a patient’s vital wellbeing is at stake.  MTX doesn’t usually clear up psoriasis all the way, so sometimes it is administered long-term in smaller doses.

One of the main risk factors associated with methotrexate is the irreparable damage it can do to the liver.  If a patient must take MTX for any length of time, periodic liver biopsies to check on the liver’s health are recommended.

MTX can also cause a severe drop in a person’s white blood cell count.  Thus, doctors will often prescribe a testing period to make sure the patient’s blood-health is not adversely affected by the drug before prescribing it in doses that can actually start clearing up psoriasis. 

Methotrexate is currently the only antimetabolite approved by the FDA as a treatment for psoriasis.

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What Is Methotrexate?

Friday, September 25th, 2009

Methotrexate is used most commonly to treat cancer because it inhibits rapid cell production.  It was found coincidentally to suppress psoriasis outbreaks, which makes sense since psoriasis causes excessive skin-cell production.  Generally, this drug is not recommended unless absolutely necessary because its side effects can be so severe (even life threatening).

Methotrexate is an extremely harsh drug that is good for fighting cancer when administered in large doses.  In smaller doses it can stop plague psoriasis outbreaks and decrease the effects of psoriatic arthritis.

Many of the detriments of using methotrexate seem to resemble those of accutane (a powerful acne medication) as both adversely affect pregnancies (or even people’s capacity to get pregnant) and have been known to cause lasting liver damage, hair loss and increased skin sensitivity.

The list of potential side effects to using methotrexate goes on and on, affecting what seems like every major bodily function.

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