JAMA Dermatol

Adding methotrexate to adalimumab offers no significant benefit in psoriasis

June 6, 2025

Study details: This retrospective cohort study used data from the British Association of Dermatologists Biologics and Immunomodulators Register to compare adalimumab monotherapy (n=1,553) vs. combination therapy with methotrexate (n=231) in adults with chronic plaque psoriasis. The primary outcome was drug survival at 12 months; secondary outcomes included Psoriasis Area and Severity Index (PASI 75) response and adverse events.

Results: At one and three years, no significant difference was observed in drug survival or PASI 75 response rates between adalimumab monotherapy and combination therapy (1-year PASI 75: 52% vs. 49%; 3-year PASI 75: 32% vs. 37%). Serious adverse event rates and adalimumab serum concentrations were also similar. However, combination therapy resulted in lower antidrug antibody levels (mean difference, -123.7 AU/mL).

Clinical impact: The findings suggest that routine addition of methotrexate to adalimumab for psoriasis may not enhance treatment durability or efficacy. Clinicians may consider monotherapy sufficient in many cases, potentially reducing medication burden and toxicity risk.

Source:

Yiu ZZN, et al; BADBIR Study Group; BSTOP Study Group. (2025, June 4). JAMA Dermatol. Adalimumab Monotherapy vs Adalimumab With Methotrexate for Psoriasis. https://pubmed.ncbi.nlm.nih.gov/40465280/