Haustein U F, Rytter M
Department of Dermatology, University of Leipzig, Germany.
J Eur Acad Dermatol Venereol. 2000 Sep;14(5):382-8. doi: 10.1046/j.1468-3083.2000.00058.x.
To evaluate the efficacy, safety and side-effects of methotrexate (MTX) in psoriasis.
A 26-year retrospective study.
Department of Dermatology, Leipzig University, Leipzig, Germany.
One hundred and fifty-seven patients with extensive plaque psoriasis, erythrodermic, pustular and arthropathic forms, were treated with low-dose methotrexate (15-20 mg maximum weekly dosage [Weinstein schedule]), the majority for long-term periods. The mean cumulative dose was 3394 mg, the mean duration 237 weeks.
The effect of MTX treatment was good in 76%, moderate in 18% and poor in 6% of subjects; 61% experienced side-effects, most frequently due to liver function abnormalities, bone marrow suppression, nausea, gastric complaints and hair loss. In 20% of cases the subjects were forced to discontinue therapy; 9% refused therapy due to physical and psychological discomfort, 2% wanted to become pregnant, 16% were lost to follow-up, 6% died from multimorbidity and old age. Three subjects (2%) developed cancer of the lung, breast or cervix uteri, possibly in relation to long-term MTX treatment. Altogether there were no deaths or life-threatening side-effects attributable to MTX treatment, and no cases of progressive liver cirrhosis apart from two extensive skin necroses due to overdosage (misunderstanding, suicidal attempt) that were treated successfully with citrovorum factor.
Low-dose MTX (<15-20 mg/week) is an effective therapy for extensive and severe forms of psoriasis if patients are selected carefully and monitored regularly, particularly with respect to liver and bone marrow toxicity. This helps to reduce severe side-effects even during long-term treatment. Drug interactions must be avoided. MTX therapy according to the guidelines is relatively safe and still has a place in the systemic treatment of psoriasis with 40 years of experience and an acceptable safety record.
评估甲氨蝶呤（MTX）治疗银屑病的疗效、安全性及副作用。
一项为期26年的回顾性研究。
德国莱比锡大学皮肤科。
157例患有广泛性斑块状银屑病、红皮病型、脓疱型及关节病型银屑病的患者接受了低剂量甲氨蝶呤治疗（最大每周剂量15 - 20 mg[温斯坦方案]），大多数患者接受长期治疗。平均累积剂量为3394 mg，平均疗程为237周。
MTX治疗效果良好的患者占76%，中等的占18%，差的占6%；61%的患者出现副作用，最常见的原因是肝功能异常、骨髓抑制、恶心、胃部不适和脱发。20%的患者被迫中断治疗；9%因身体和心理不适拒绝治疗，2%因想怀孕拒绝治疗，16%失访，6%因多种疾病和年老死亡。3例患者（2%）发生肺癌、乳腺癌或宫颈癌，可能与长期MTX治疗有关。总体而言，没有因MTX治疗导致的死亡或危及生命的副作用，除了两例因过量用药（误解、自杀未遂）导致的广泛性皮肤坏死外，没有进展性肝硬化病例，这两例经亚叶酸成功治疗。
如果仔细选择患者并定期监测，特别是关注肝脏和骨髓毒性，低剂量MTX（<15 - 20 mg/周）是治疗广泛性和严重型银屑病的有效疗法。这有助于减少即使在长期治疗期间的严重副作用。必须避免药物相互作用。按照指南进行的MTX治疗相对安全，在银屑病的系统治疗中仍占有一席之地，已有40年经验且安全性记录可接受。
