{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:30:49Z","timestamp":1793932249306,"version":"4.8.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Psoriasis is a chronic, inflammatory disease with no cure. Methotrexate (MTX) and acitretin (ACI) are well-established, FDA-approved systemic therapies for chronic plaque psoriasis. However, randomized trials evaluating their combination in fixed low doses are limited due to concerns of additive hepatotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim and Objectives:<\/jats:title>\n                    <jats:p>To assess and compare efficacy and safety of treatment with MTX (0.3 mg\/kg\/week) versus low-dose MTX (0.15 mg\/kg\/week) plus low-dose ACI (0.3 mg\/kg\/day) in patients with chronic plaque psoriasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>This was a nonblinded randomized controlled trial. Patients with chronic plaque psoriasis having body surface area (BSA)&gt;10% and psoriasis area severity index (PASI)&gt;10 were randomized into two groups. One group received intramuscular MTX 0.3 mg\/kg\/week, and the other received intramuscular MTX 0.15 mg\/kg\/week plus oral ACI 0.3 mg\/kg\/day. Patients were followed every 2 weeks for first 4 weeks and monthly thereafter till 16 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 134 patients (67 in each group) were analyzed. Baseline BSA and PASI were comparable between groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.54 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.82, respectively) and showed significant reduction at 16 weeks in both arms (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04). PASI-75, 90, and 100 at 16 weeks were slightly higher in monotherapy group but not statistically significant on per-protocol or intention-to-treat analyses. Onset of action was significantly earlier in monotherapy group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). Laboratory and clinical adverse effects between groups were mild and manageable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Nonblinded, absence of ACI monotherapy arm, limited study duration, and lack of noninvasive hepatic fibrosis assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Low-dose MTX plus ACI is a safe and effective alternative to standard-dose MTX in chronic plaque psoriasis, provided regular monitoring and follow-up are ensured.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/idoj.idoj_1317_25","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:00:45Z","timestamp":1791468045000},"page":"794-801","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Treatment with Methotrexate Versus a Combination of Low Dose of Methotrexate Plus Low Dose of Acitretin in Chronic Plaque Psoriasis: A Randomised Nonblinded Controlled Trial"],"prefix":"10.4103","volume":"17","author":[{"given":"Satyendra K.","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5572-5779","authenticated-orcid":false,"given":"Sagnik","family":"De","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"R1-20261106","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0140-6736(07)61128-3","article-title":"Pathogenesis and clinical features of psoriasis","volume":"370","author":"Griffiths","year":"2007","journal-title":"Lancet"},{"key":"R2-20261106","first-page":"550","article-title":"Psoriasis in the tropics: An epidemiological survey","volume":"41","author":"Okhandiar","year":"1963","journal-title":"J Indian Med Assoc"},{"key":"R3-20261106","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.tox.2013.01.020","article-title":"Acitretin affects bioenergetics of liver mitochondria and promotes mitochondrial permeability transition: Potential mechanisms of hepatotoxicity","volume":"306","author":"Silva","year":"2013","journal-title":"Toxicology"},{"key":"R4-20261106","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1111\/j.1365-2133.2010.09755.x","article-title":"British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology","volume":"162","author":"Ormerod","year":"2010","journal-title":"Br J Dermatol"},{"key":"R5-20261106","doi-asserted-by":"crossref","first-page":"e0153740","DOI":"10.1371\/journal.pone.0153740","article-title":"Safety and efficacy of methotrexate in psoriasis: A meta-analysis of published trials","volume":"11","author":"West","year":"2016","journal-title":"PLoS One"},{"key":"R6-20261106","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/archderm.142.8.1000","article-title":"Low-dose acitretin is associated with fewer adverse events than high-dose acitretin in the treatment of psoriasis","volume":"142","author":"Pearce","year":"2006","journal-title":"Arch Dermatol"},{"key":"R7-20261106","doi-asserted-by":"crossref","first-page":"400","DOI":"10.3109\/09546634.2011.588192","article-title":"Efficacy of low-dose acitretin in the treatment of psoriasis","volume":"23","author":"Haushalter","year":"2012","journal-title":"J Dermatolog Treat"},{"key":"R8-20261106","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1046\/j.1440-1746.2001.02644.x","article-title":"Role of non-alcoholic steatohepatitis in methotrexate-induced liver injury","volume":"16","author":"Langman","year":"2001","journal-title":"J Gastroenterol Hepatol"},{"key":"R9-20261106","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1046\/j.1365-2036.2004.01819.x","article-title":"Monitoring methotrexateinduced hepatic fibrosis in patients with psoriasis: Are serial liver biopsies justified?","volume":"19","author":"Aithal","year":"2004","journal-title":"Aliment Pharmacol Ther"},{"key":"R10-20261106","doi-asserted-by":"crossref","first-page":"357","DOI":"10.2165\/00128071-200506060-00003","article-title":"Monitoring liver function during methotrexate therapy for psoriasis: Are routine biopsies really necessary?","volume":"6","author":"Thomas","year":"2005","journal-title":"Am J Clin Dermatol"},{"key":"R11-20261106","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/09546630701759579","article-title":"Concurrent use of methotrexate and acitretin revisited","volume":"19","author":"Lowenthal","year":"2008","journal-title":"J Dermatolog Treat"},{"key":"R12-20261106","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.phrs.2017.04.014","article-title":"The acitretin and methotrexate combination therapy for psoriasis vulgaris achieves higher effectiveness and less liver fibrosis","volume":"121","author":"An","year":"2017","journal-title":"Pharmacol Res"},{"key":"R13-20261106","first-page":"315","article-title":"Proceedings of the psoriasis combination and rotation therapy conference","volume":"34","author":"Menter","year":"1994","journal-title":"Deer Valley, Utah, Oct. 7-9"},{"key":"R14-20261106","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.2147\/DDDT.S304168","article-title":"Incidence and risk factors of hepatic fibrosis in psoriatic patients receiving methotrexate with concomitant acitretin therapy and methotrexate monotherapy","volume":"15","author":"Rattanakaemakorn","year":"2021","journal-title":"Drug Des Devel Ther"},{"key":"R15-20261106","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jaad.2009.03.027","article-title":"Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents","volume":"61","author":"Menter","year":"2009","journal-title":"J Am Acad Dermatol"},{"key":"R16-20261106","first-page":"310","article-title":"Psoriasis in North India. Geographical variations","volume":"155","author":"Bedi","year":"1977","journal-title":"Dermatologica"},{"key":"R17-20261106","first-page":"595","article-title":"Psoriasis in India: Prevalence and pattern","volume":"76","author":"Dogra","year":"2010","journal-title":"Indian J DermatolVenereolLeprol"},{"key":"R18-20261106","first-page":"202","article-title":"Clinical profile of psoriasis in North India","volume":"61","author":"Bedi","year":"1995","journal-title":"Indian J DermatolVenereolLeprol"},{"key":"R19-20261106","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/j.1346-8138.1997.tb02779.x","article-title":"Natural history of psoriasis: A study from the Indian subcontinent","volume":"24","author":"Kaur","year":"1997","journal-title":"J Dermatol"},{"issue":"(Suppl 2)","key":"R20-20261106","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1468-3083.2011.03990.x","article-title":"Evidence-based recommendations on conventional systemic treatments in psoriasis: Systematic review and expert opinion of a panel of dermatologists","volume":"25","author":"Paul","year":"2011","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R21-20261106","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/ijd.IJD_300_18","article-title":"Fixed tapering dosage of acitretin in patients with psoriasis: A short-term analysis of clinical efficacy and its effects on biochemical parameters","volume":"64","author":"Pai","year":"2019","journal-title":"IndianJ Dermatol"},{"key":"R22-20261106","doi-asserted-by":"crossref","first-page":"426","DOI":"10.2340\/00015555-2599","article-title":"Methotrexate use and monitoring in patients with psoriasis: A consensus report based on a Danish expert meeting","volume":"97","author":"Raaby","year":"2017","journal-title":"Acta Derm Venereol"},{"key":"R23-20261106","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1056\/NEJMoa021359","article-title":"Methotrexate versus cyclosporine in moderate-to-severe chronic plaque psoriasis","volume":"349","author":"Heydendael","year":"2003","journal-title":"N Engl J Med"},{"key":"R24-20261106","first-page":"116","article-title":"Methotrexate vs. ciclosporin in psoriasis: Effectiveness, quality of life and safety. A randomized controlled trial","volume":"158","author":"Flytstr\u00f6m","year":"2008","journal-title":"Br J Dermatol"},{"key":"R25-20261106","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":"R26-20261106","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/ard.2004.024463","article-title":"A randomised, double blind, placebo controlled, multicentre trial of combination therapy with methotrexate plus ciclosporin in patients with active psoriatic arthritis","volume":"64","author":"Fraser","year":"2005","journal-title":"Ann Rheum Dis"},{"key":"R27-20261106","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0190-9622(89)70236-X","article-title":"A double-blind, placebo-controlled trial of acitretin for the treatment of psoriasis","volume":"21","author":"Olsen","year":"1989","journal-title":"J Am AcadDermatol"},{"key":"R28-20261106","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/S0190-9622(88)70198-X","article-title":"Acitretin versus etretinate in psoriasis. Clinical and pharmacokinetic results of a German multicenter study","volume":"19","author":"Gollnick","year":"1988","journal-title":"J Am AcadDermatol"},{"key":"R29-20261106","first-page":"e305","article-title":"Efficacy and safety of acitretin in three fixed doses of 25, 35 and 50 mg in adult patients with severe plaque type psoriasis: A randomized, double blind, parallel group, dose ranging study","volume":"27","author":"Dogra","year":"2013","journal-title":"J EurAcadDermatol Venereol"},{"key":"R30-20261106","doi-asserted-by":"crossref","first-page":"18","DOI":"10.51273\/esc23.251914","article-title":"Comparison of efficacy of methotrexate versus acitretin in the treatment of chronic plaque psoriasis","volume":"19","author":"Siddiqui Saadiya","year":"2023","journal-title":"Esculapio"},{"key":"R31-20261106","doi-asserted-by":"crossref","first-page":"471","DOI":"10.29054\/apmc\/2023.1355","article-title":"Evaluating the relative effectiveness of methotrexate and acitretin in chronic plaque psoriasis treatment","volume":"17","author":"Younis","year":"2023","journal-title":"APMC"}],"container-title":["Indian Dermatology Online Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_1317_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:00:36Z","timestamp":1793930436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_1317_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/idoj.idoj_1317_25","relation":{},"ISSN":["2229-5178","2249-5673"],"issn-type":[{"value":"2229-5178","type":"print"},{"value":"2249-5673","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"2025-10-30","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}