| Background Psoriasis is a chronic inflammatory disease caused by the interaction of genetic,immune environment,and other factors.The etiology and pathogenesis is still not clear,there is still no cure for psoriasis clinically,and symptomatic support therapy is mostly adopted.Although there are many effective methods for the treatment of psoriasis,such as phototherapy,traditional Chinese medicinal bath,external preparations,systematic treatment drugs,biological agents,etc.,the effect is very different between different treatment methods.Both methotrexate(MTX)and acitretin are effective systemic drugs for psoriasis,but their use is limited due to adverse drug reactions.Objective By studying the effective rate and the incidence of adverse reactions of MTX and acitretin in the treatment of psoriasis,we can deepen our understanding of the effectiveness and safety of MTX and acitretin,and understand the limitations of the two drugs in the application of psoriasis in China,so as to provide more evidence for our clinical treatment of psoriasis.Method Detailed information of 100 patients with moderate to severe psoriasis vulgaris in the ward and outpatient department of our hospital was collected,among which 50 patients were treated with MTX and the other 50 patients were treated with acitretin.The patients' rash recovery before and after treatment was recorded in detail,and the clinical effects of MTX and acitretin were evaluated by PASI score,BSA score and DLQI score.The laboratory test results(Blood routine,Liver and kidney function examination,Lipoid test,etc.)and clinical manifestations of the patients during the treatment and the recurrence of the patients within 3 months after the treatment were collected as the assessment of adverse drug reactions.Results1.Basic clinical data A total of 100 patients were included in this retrospective study,and the two groups were comparable in age,duration of illness,time of exacerbation,and age of disease,P > 0.01.2.Comparison of efficacy indexes between the two groups After drug treatment,there were statistically significant differences in PASI score and DLQI score between the two groups(P < 0.05).Acitretin was higher than MTX in both PASI score and DLQI score,indicating that MTX was more satisfactory in alleviating the severity of skin lesions in patients with moderate to severe psoriasis vulgare.In terms of BSA score,the difference between groups was not statistically significant(P > 0.05),indicating that there was no significant difference in the efficacy of MTX and acitretin in alleviating skin lesion area.In terms of DLQI,there was no significant difference between the two drugs in improving the life index of patients with psoriasis.3.Time when the skin lesion began to recede In the acitretin group,the fastest onset was 2 days,the slowest was 16 days,and the most onset was within 1 week,with an average of 8.58±3.552 days.In the MTX group,the fastest onset was 4 days,and the slowest onset was 28 days,with an average onset of 14.42±12.000 days.The difference of skin lesion regression time between the two groups was statistically significant,P < 0.05.It can be seen that the onset time of skin lesions in the acitretin group after 12 w of treatment was shorter than that in the MTX group,indicating that the acitretin effect was faster.4.Efficiency The effective rate of the two groups after 4w treatment was compared.The effective rate of the MTX group was 16%,and that of the acitretin group was 34%,P > 0.05.Although the effective rate of the acitretin group was higher than that of the MTX group,the results were not statistically significant.After 8w treatment,the effective rate of MTX group and acitretin group was 54% and 38% respectively,P < 0.05,suggesting that the overall effective rate of MTX after 8w treatment was higher than that of acitretin.The effective rate of MTX group and acitretin group was 68% and 44%respectively after 12 w of treatment,P < 0.05,suggesting that the overall effective rate of MTX was still higher than that of acitretin group after 12 w of treatment.Overall,MTX is more effective.5.Adverse reactions Although the incidence of adverse reactions in the acitretin group was higher than that in the MTX group,the overall adverse reactions were mild and recovered after timely treatment without dosage reduction or drug withdrawal.Although the incidence of adverse reactions in the MTX group was low,the side effects were slightly severe,especially in the case of liver damage,it was better to reduce dosage or drug withdrawal.In this study,there were no serious adverse reactions,such as myelosuppression and irreversible liver injury,indicating that both groups of drugs were safe to some extent.6.Recurrence within 3 monthsThe 96 patients in this study were asked whether their condition recurred within 3months after the end of treatment.There were 49 cases in MTX group,among which 10 cases had recurrence,and the recurrence rate was 20.41%.A total of 47 patients in the acitretin group had recurrence in 12 of them,with a recurrence rate of25.53%.Compared with the two groups,P=0.810 > 0.05,although the recurrence rate of MTX group was less than that of acitretin group,there was no significant statistical difference.Conclusions In this retrospective observational study,showed that both MTX and acitretin were proved to be safe and effective drugs in the treatment of moderate to severe psoriasis vulgaris.Although acitretin is effective quickly,there are many side effects such as pruritus,dry skin and dry mouth,while methotrexate has stable efficacy,high safety and affordable price,which can be accepted by most patients and is worthy of wide clinical application. |
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