Comparison of the efficacy of Methotrexate (Mtx) and Apremilast (Apr) in psoriasis

The study desigin is Quasi experimental study. Primary objective of the study will be to compare the efficacy of Methotrexate and Apremilast in patients with Psoriasis and to compare the adverse effects associated with both the drugs. Patients diagnosed with psoriasis attending the Dermatology OPD in Yenepoya Medical College Hospital, Mangalore will be enrolled for the study. Eligible patients with Psoriasis will be treated with Methotrexate or Apremilast. Outcome will be measured at the end of treatment.  Clinical evaluation will be done for every patients.Psoriasis area severity index (PASI) will be calcilated. Blood investigations like complete blood picture, Liver function test will be done in all subjects as required for treatment. Every alternative patient will be put on either Methotrexate or Apremilast. Methotrexate will be given 7.5 mg/week orally with requisite clinical and laboratory monitoring. Weekly monitoring for first month or as required. Apremilast will be given 30 mg BID orally. Initially dose will be titrated from 10 mg/ day with gradually increasing to 30 mg BID over a week. Patient will be evaluated every month for 4 months. Patient is not supposed to use any topical treatment other than emollients during study time.This study will highlight the advantages of the less commonly used drug for treatment of psoriasis. Apremilast does not require frequent monitoring compared to Methotrexate and improves the quality of life in patients.