Comparison of adalimumab with methotrexate for psoriasis: A meta-analysis of randomized controlled studies

Abstract

Introduction: The efficacy of adalimumab versus methotrexate for psoriasis remained controversial. We conducted this systematic review and meta-analysis to explore the influence of adalimumab versus methotrexate on treatment efficacy for psoriasis patients. Methods: We have searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through August 2023 for randomized controlled trials (RCTs) assessing the efficacy of adalimumab versus methotrexate for psoriasis. This meta-analysis was performed using the random-effect or fixed-effect model based on the heterogeneity. Results: Four RCTs and 733 patients with psoriasis were included in this meta-analysis. Overall, compared with methotrexate treatment, adalimumab treatment was associated with improved Psoriasis Area and Severity Index 75 (PASI 75, odd ratio [OR] = 4.50; 95% confidence interval [CI] = 2.81–7.22; P < .00001), physician global assessment (PGA) 0/1 response (OR = 4.86; 95% CI = 3.02–7.82; P < .00001), PASI 100 (OR = 3.01; 95% CI = 1.33–6.80; P = .008) and decreased Dermatology Life Quality Index (DLQI, standard mean difference [SMD] = −0.60; 95% CI = −0.84 to −0.36; P < .00001), but exhibited no impact on PASI 90 (OR = 3.30; 95% CI = 0.77–14.20; P = .11), adverse events (OR = 1.23; 95% CI = 0.26–5.87; P = .79) or serious adverse events (OR = 2.59; 95% CI = 0.49–13.79; P = .26). Conclusions: Adalimumab was superior to methotrexate for the treatment of psoriasis.