The Combined Use of Methotrexate and Metformin Versus Methotrexate Alone in Psoriasis Patients with Metabolic Syndrome

Background: Psoriasis is a chronic skin disease and associated with significant morbidity and mortality. In addition, its treatment is a clinical challenge. When psoriasis is associated with metabolic syndrome, the treatment challenge is increased and new treatment approaches are continuously introduced. The aim of the work: This work aimed to investigate the value of adding metformin to methotrexate in treatment of psoriasis with metabolic syndrome regarding efficacy and safety. Patients and Methods: The study included 40 patients with psoriasis and metabolic syndrome, who were randomly divided into two equal groups, the first treated by methotrexate plus metformin and the second treated by methotrexate alone for 12 weeks. The disease area and severity index (PASI) score was used to assess the severity of the condition. After initiation of treatment, the patients were evaluated on regular visits at 1, 2 and 3 months after imitation of treatment. The PASI and laboratory workup were used to assess the efficacy of the treatment. Any side effects were document. Results: The PASI score in group I was 21.55±8.55 before treatment. Then, it was reduced to 16.2±2.88, 10.95±4.3 and 8.25±2.1 at 1,2 and 3 months after initiation of treatment. The corresponding values in group II were 23.55±13.14, 17.5±4.1, 12.7±2.58 and 9.35±2.06 before and after 1, 2, 3 months of initiation of treatment successively. No significant differences were recorded between both groups at any time of treatment follow up. In addition, no significant differences were observed regarding other laboratory indicators, except significant difference of gamma glutamyl transferase at 1,2,3 months. Conclusion: The addition of metformin to methotrexate in treatment was not associated with a significant additional benefits on the PASI score or laboratory values in patients with psoriasis and metabolic syndrome. However, the combined use was relatively safe and well-tolerated.