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Comparison of cardiovascular risk in psoriasis patients taking methotrexate and apremilast
*Corresponding author: Sebastian Criton, Department of Dermatology, Amala Medical College, Thrissur, Kerala, India. criton@thecriton.com
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Received: ,
Accepted: ,
How to cite this article: Varghese A, Criton S, George R. Comparison of cardiovascular risk in psoriasis patients taking methotrexate and apremilast. J Skin Sex Transm Dis. 2025;7:110-1. doi: 10.25259/JSSTD_78_2025
Dear Authors,
Thank you for your interest in our study.[1] We appreciate your thoughtful questions and your valuable time to read our work. We have carefully considered your questions[2] and would like to offer the following clarifications. We would be happy to clarify further if needed.
The reduction of psoriasis area and severity index was more for apremilast compared to methotrexate, which was a technical mistake from our side. Thank you for pointing out the mistake.
Once a drug is administered, to know whether it is cardioprotective or not we can either wait for 5-10 years to watch for the cardiovascular events or measure the risk factors that can predict these events, which can be done earlier. It is observed that for a drug to alter these risk factors, it will take an average of 3 months, which is why we chose this as the follow-up period. Our study is biomarker-based and not a cardiovascular event-based one, so we looked for changes in the risk factors and not the cardiovascular events, which will occur only later.
We do agree this as a limitation of our study.
Basically, there is an interplay of three pathways before a coronary event – lipid pathway, an inflammatory pathway, and platelet thrombus formation. In this study, we selected the proven biomarkers pertaining to each of these pathways, which are the high-sensitivity C-reactive protein of the inflammatory pathway, thromboxane of the thrombus formation, and the conventional risk factors like lipid profile, which we found were sufficient. All other risk factors that you have listed would not be financially feasible.
With a fixed dose, the side effects are less, and hence, we selected this dose.
About the thromboxane levels, five patients showed raised levels, of which four patients in the methotrexate group had raised levels and only one in apremilast had raised levels. All five patients showed a decrease in thromboxane levels after treatment with methotrexate and apremilast.
The practice in our department is to use systemic therapy if the body surface area is more than 5%, and hence, we have not included patients using topical therapies other than emollients.
In conclusion, these queries raise important questions that point toward further studies on this topic.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
References
- Effect of apremilast on cardiovascular risk in psoriasis patients in comparison with methotrexate. J Skin Sex Transm Dis. 2024;6:31-6.
- [CrossRef] [Google Scholar]
- Critical appraisal of cardiovascular risk assessment in psoriasis: A response to Varghese et al. J Skin Sex Transm Dis
- [CrossRef] [Google Scholar]