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Methotrexate least expensive therapy to achieve PASI 75 in patients with psoriasis

Methotrexate was found to be the least expensive FDA-approved treatment for patients with psoriasis; however, potential toxicities may limit its long-term use, according to researchers.

Using PubMed, the researchers conducted a literature review of systemic medications for psoriasis approved by the FDA with a primary endpoint of 75% reduction in the Psoriasis Area and Severity Index score (PASI 75). They used wholesale acquisition cost (WAC) to calculate medication costs, with laboratory fees determined by the American Medical Association and offices fees the standard cost at the University of Connecticut.

The researchers standardized total expenses by calculating cost per month of treatment considering the number needed to treat (NNT) to achieve PASI 75. Overall, 26 studies including 39 treatment regimens and 7,099 patents were included in the study.

The lowest adjusted monthly costs per NNT to achieve PASI 75 were reported for methotrexate ($794.05-$1,502.51) and cyclosporine ($1410.14 for 3 mg/kg/day-$1,843.55 for 5 mg/kg/day). Infliximab ($8,704.68-$15,235.52) and ustekinumab 90 mg ($12,505.26-$14,256.75) were the most expensive therapies, according to the researchers.

Other therapies had the following adjusted monthly costs per NNT to achieve PASI 75: narrowband ultraviolet B light phototherapy, $2,924.73; adalimumab, $3,974 to $7,678.78; acitretin, $4,137.71 to $14,148.53; ustekinumab 45 mg, $7,177.89 to $7263.99; psoralen plus ultraviolet A light photography, $7,499.46 to $8,834.98; and etanercept, $8,284.71 to $10,674.89.

The researchers concluded that as new therapies become available that promise higher efficacies of PASI 90 and PASI 100, they will need to be more cost-effective than those currently available. 

Disclosures: D’Souza reports no relevant financial disclosures. See the study for other relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.