{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T02:45:41Z","timestamp":1744166741098},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Psoriasis is a common chronic, immune-mediated inflammatory skin disease. Despite the availability of several systemic therapeutic agents, treatment of psoriasis remains a challenge because of the associated adverse effects and\/or the financial burden of these medications, given the chronicity of the disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to compare the efficacy and safety of combined pulse azathioprine (AZA) and low-dose methotrexate (MTX) vs. a conventional dose of MTX in patients with chronic plaque psoriasis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this randomized controlled trial, 67 patients with moderate-to-severe plaque psoriasis were randomized into two groups, receiving either combined pulse AZA (300 mg weekly dose) and low-dose MTX (10 mg weekly) or conventional-dose MTX (0.3 mg kg\u22121 per week) for 16 weeks. Patients were assessed for treatment response using the Psoriasis Area and Severity Index (PASI) score and for the development of any adverse effects at weeks 12 and 16, and for a further 3 months after stopping treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A statistically significantly higher proportion of the patients receiving combined pulse AZA and low-dose MTX achieved \u2265 90% improvement in PASI and 100% improvement (PASI 100) at week 12, and PASI 100 at week 16, compared with those receiving the conventional dose of MTX as monotherapy. No serious adverse events were reported during the entire study period in the two groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Combination therapy using pulse AZA and low-dose MTX can be an efficacious treatment for moderate-to-severe plaque psoriasis, with a relatively good safety profile.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ced\/llae078","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T09:29:09Z","timestamp":1710235749000},"page":"1029-1035","source":"Crossref","is-referenced-by-count":1,"title":["Pulse azathioprine and low-dose methotrexate vs. standard-dose methotrexate in treatment of patients with moderate-to-severe psoriasis: a randomized controlled trial"],"prefix":"10.1093","volume":"49","author":[{"given":"Mohamed Hussein Medhat","family":"El-Komy","sequence":"first","affiliation":[{"name":"Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadiga S","family":"Sayed","sequence":"additional","affiliation":[{"name":"Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gehad","family":"Gawish","sequence":"additional","affiliation":[{"name":"Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menatallah\u00a0Mohamed","family":"Elaguizy","sequence":"additional","affiliation":[{"name":"Clinical and Chemical Pathology, Faculty of Medicine, Cairo University , Cairo , Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yousra","family":"Azzazi","sequence":"additional","affiliation":[{"name":"Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"2024082301135659200_llae078-B1","first-page":"278","article-title":"Diagnosis and management of psoriasis","volume":"63","author":"Kim","year":"2017","journal-title":"Can Fam Physician"},{"key":"2024082301135659200_llae078-B2","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.3389\/fimmu.2018.01323","article-title":"The interleukin-23\/interleukin-17 axis links adaptive and innate immunity in psoriasis","volume":"9","author":"Sch\u00f6n","year":"2018","journal-title":"Front Immunol"},{"key":"2024082301135659200_llae078-B3","first-page":"97","article-title":"Current developments in the immunology of psoriasis","volume":"93","author":"Gr\u00e4n","year":"2020","journal-title":"Yale J Biol Med"},{"key":"2024082301135659200_llae078-B4","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/ced.12887","article-title":"Effectiveness of weekly azathioprine pulse in the treatment of chronic plaque psoriasis: an open-label study","volume":"41","author":"Verma","year":"2016","journal-title":"Clin Exp Dermatol"},{"key":"2024082301135659200_llae078-B5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/ced.12062","article-title":"Systemic methotrexate therapy for psoriasis: past, present and future","volume":"38","author":"Dogra","year":"2013","journal-title":"Clin Exp Dermatol"},{"key":"2024082301135659200_llae078-B6","first-page":"21","article-title":"Monitoring methotrexate-induced liver fibrosis in patients with psoriasis: utility of transient elastography","volume":"8","author":"Cheng","year":"2018","journal-title":"Psoriasis (Auckl)"},{"key":"2024082301135659200_llae078-B7","doi-asserted-by":"crossref","first-page":"e15656","DOI":"10.1111\/dth.15656","article-title":"Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis","volume":"35","author":"Dogra","year":"2022","journal-title":"Dermatol Ther"},{"key":"2024082301135659200_llae078-B8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.25259\/IJDVL_613_19","article-title":"Safety and efficacy of methotrexate (0.3 mg\/kg\/week) versus a combination of methotrexate (0.15 mg\/kg\/week) with cyclosporine (2.5 mg\/kg\/day) in chronic plaque psoriasis: a randomised non-blinded controlled trial","volume":"87","author":"Singh","year":"2021","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2024082301135659200_llae078-B9","doi-asserted-by":"crossref","first-page":"e14513","DOI":"10.1111\/dth.14513","article-title":"Is weekly azathioprine pulse effective and safe in dermatological conditions?","volume":"34","author":"Verma","year":"2021","journal-title":"Dermatol Ther"},{"key":"2024082301135659200_llae078-B10","first-page":"58","article-title":"A physician\u2019s guide to azathioprine metabolite testing","volume":"2","author":"Cuffari","year":"2006","journal-title":"Gastroenterol Hepatol (N Y"},{"key":"2024082301135659200_llae078-B11","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-90107-7","volume-title":"Evidence-Based Psoriasis","author":"Bhutani","year":"2018"},{"key":"2024082301135659200_llae078-B12","first-page":"8696597","article-title":"Systematic review and recommendations to combine newer therapies with conventional therapy in psoriatic disease","volume":"8","author":"Arora","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"2024082301135659200_llae078-B13","first-page":"152","article-title":"Comparison of methotrexate and azathioprine in the treatment of psoriasis: a randomized controlled trial","volume-title":"J\u00a0Pakistan Assoc 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