# Evaluation of the Therapeutic and Economic Impact of Adalimumab Versus Methotrexate in the Management of Psoriasis: A Prospective Comparative Study

## TL;DR

This study compares adalimumab and methotrexate for psoriasis, finding that adalimumab is more effective but much more expensive.

## Contribution

The study provides real-world comparative data on the clinical and economic outcomes of adalimumab versus methotrexate in psoriasis treatment.

## Key findings

- Adalimumab showed significantly higher PASI 75/90 response rates and greater improvement in quality of life compared to methotrexate.
- Adalimumab had a much higher treatment cost and cost-effectiveness ratio than methotrexate.
- Both treatments had similar safety profiles, but adalimumab's economic burden limits its use in resource-limited settings.

## Abstract

Background: Psoriasis is a chronic inflammatory skin disease often requiring systemic therapy for moderate-to-severe cases. Methotrexate (MTX) is a cost-effective conventional treatment, while adalimumab (ADL), a tumor necrosis factor-alpha (TNF-α) inhibitor, offers higher efficacy but at a significantly higher cost. Comparative real-world data on their effectiveness, safety, and cost-efficiency in resource-limited settings remain scarce.

Aim: In the present study, we aimed to compare the therapeutic efficacy, safety profile, and cost-effectiveness of ADL versus MTX in the treatment of moderate-to-severe plaque psoriasis.

Methods: This prospective, observational study was conducted with 80 (100%) adult patients, divided equally into the ADL group (n=40, 50%) and the MTX group (n=40, 50%). Patients were evaluated over 24 weeks for clinical efficacy (Psoriasis Area Severity Index (PASI) 75/90 response rates), safety (adverse drug reactions (ADRs)), quality of life (Dermatology Life Quality Index (DLQI) scores), and pharmacoeconomic parameters, including average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER).

Results: At week 24, PASI 75 and PASI 90 responses were significantly higher in the ADL group (n=25, 62.16% and n=11, 27% respectively) compared to the MTX group (n=10, 23.7% and n=1, 2.63% respectively) (p<0.05). ADL showed greater mean PASI reduction (8.95 vs. 6.58; p<0.001) and DLQI improvement (8.22 vs. 4.89; p<0.001). Adverse events were similar between groups. However, ADL incurred a markedly higher treatment cost (₹97,500 vs. ₹396.4). The ACER per PASI 75 responder was ₹156,784.42 for ADL versus ₹1,672.15 for MTX. ICER for an additional PASI 75 responder with ADL was ₹252,553.97.

Conclusions: ADL demonstrated superior clinical efficacy and quality-of-life improvement over MTX but at a substantially higher cost. Despite its effectiveness, ADL’s economic burden limits its feasibility in resource-constrained settings. MTX remains the more cost-effective option, underscoring the need for affordability-enhancing measures for biologics in India.