Combination of methotrexate with oral disease-modifying antirheumatic drugs in psoriatic arthritis: a systematic review

Background: Oral conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), especially methotrexate, are the cornerstone of treating psoriatic arthritis (PsA). The use of csDMARDs with biologics has increased their efficacy in psoriasis. However, the combination of two oral DMARDs in patients with PsA has not been adequately reviewed. In this study, we explore the combinational use of methotrexate with DMARDs in PsA patients. Materials & methods: A review was conducted using Medline (PubMed), Embase, Web of Science and the Cochrane Library, covering articles up to February 2023. Results & conclusion: Nine studies comprising 1993 participants were included. The evidence supporting combination therapy remains limited. Combinational therapy could be considered in patients with inadequate response to monotherapy or no access to biologics. This study aimed to determine whether combining two different medicines could serve as an option for patients with psoriatic arthritis (PsA). Typically, doctors prescribe just one medicine, but sometimes its efficacy is limited. After reviewing nine studies with 1993 participants, it appears that using two medicines together might be an alternative option for PsA patients who do not experience sufficient relief from a single medicine. This research contributes to our understanding of using this combination approach for PsA and suggests that further larger studies could confirm its potential as a beneficial method for improving the health of these patients.