Comparative efficacy of methotrexate, apremilast and their combination in psoriasis vulgaris.

Psoriasis is a common, chronic, non-contagious inflammatory skin disorder characterized by sharply demarcated, red plaques with silvery white scaling, which may occur on any part of the body but preferentially over extensor areas and scalp. While methotrexate is highly efficacious, the wide array of side effects restrict its use in the long term and mandate the need for strict periodical monitoring and a limited total cumulative dose. On the other hand, apremilast is a relatively safer drug but its efficacy in Indian population is not yet established. The present study aims to assess its efficacy and compare it with the gold standard, methotrexate. Since no single drug is completely effective in the treatment and maintenance of this chronic disease, the present study also aims to assess the efficacy of the combination of two drugs to ascertain if apremilast could enhance the efficacy of methotrexate, leading to less adverse effects, reduced dosage and duration of therapy of methotrexate.