The METOP Study: Further Evidence for the Use of Subcutaneous Methotrexate in Psoriasis.

Please cite this article as: Morgado-Carrasco D, Fustà-Novell X, Riera Monroig J, Mascaró Galy JM. RF-The METOP Study: Further Evidence for the Use of Subcutaneous Methotrexate in Psoriasis. Actas Dermosifiliogr. 2017;108:865--866. ∗ Corresponding author. E-mail address: [email protected] (J.M. Mascaró Galy). patients, and side effects that required drug withdrawal in 6.9%. A clinical trial of briakinumab versus MTX found that only 23.9% of patients receiving MTX achieved a PASI75 at 52 weeks, and that 72% (118/163) discontinued the drug due to lack of efficacy (95/163), side effects (9/163), or other reasons. Regarding the route of administration, some studies in rheumatoid arthritis suggest greater efficacy of methotrexate when given by subcutaneous injection (MTXSC). Warren et al. recently published the results of the European METOP study, a multicenter randomized, double-blind clinical trial of MTXSC versus placebo in patients with moderate to severe plaque psoriasis (PASI ≥ 10). During the first 16 weeks, patients received placebo (n = 29) or MTXSC (n = 91) at a dose of 17.5 mg/week, increasing to 22.5 mg/week depending on the clinical response at week 8. Subsequently, all patients received MTXSC up to week 52. At week 16, 41% of the MTXSC group and 10% of the placebo group achieved PASI75 (relative risk: 3.93; 95% confidence interval, 1.3111.81; P = .0026). At week 52, 45% (n = 41) of patients had achieved a PASI75, and 28% a PASI90. MTXSC was well tolerated, with no reports of death, serious infections, or major cardiovascular events. Of the patients who received the drug for 52 weeks, 3% (n = 3) presented gastrointestinal intolerance requiring treatment discontinuation. Biopsies were performed on 27 patients prior to treatment and during week 16, observing a marked reduction in interleukin 17 and interferonmRNA levels in those individuals with MTXSC who achieved a PASI75. These results after 12 to 16 weeks of treatment with MTXSC are similar to those observed previously with oral