Impact of methotrexate administration route on drug survival in psoriasis: Results from PSOBIOTEQ

Background There are limited data on the impact of the route of administration of methotrexate (MTX) on drug survival in psoriasis. Objective To evaluate the impact of the initial route of administration of MTX (monotherapy) on drug survival in patients with moderate to severe skin psoriasis. Materials and Methods A prospective cohort study based on the Psobioteq registry, included from July 2012 to January 2023, patients with plaque, erythrodermic or guttate psoriasis, naive to MTX, biologics and apremilast, who initiated MTX monotherapy. Factors associated with drug survival were identified using Kaplan–Meier curves and Cox regression analyses. Results In total, 406 patients were included, 58.1% received MTX per os (MTX‐PO) and 41.9% subcutaneously (MTX‐SC). At MTX initiation, the median PASI score was 11, and 67.3% had DLQI ≥6. Adjusted drug survival did not statistically differ according to the route of administration ( p = 0.15). Limitations Limited number of patients leading to a potential lack of power. Residual confounding cannot be waived due to the observational nature of the data. Conclusion Overall MTX survival did not significantly differ according to the route of administration. However, with MTX‐SC, the hazard of discontinuation for ineffectiveness was lower and of discontinuation for intolerance was higher than with MTX‐PO.