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Dermbits

MD, MPH

How do you transition a psoriasis patient from methotrexate to a biologic? Can you use them concurrently?

Psoriasis

You. In most of my patients, if I had to transition from a patient from methotrexate to a biologic medication, I first would not do anything to the methotrexate dose and I would continue the methotrexate while the biologic is getting started. And then I wait until the patient is clear or almost clear or really significantly better year, at which point I then would discontinue the methotrexate altogether. Methotrexate is a medication that can be discontinued without tapering. So I tend to do that at that point because I wanted to see how the patient will do on monotherapy of biologic and then if the patient later on start to have return of disease on this monotherapy of biologic, then I would add a little bit of methotrexate back until the lowest methotrexate dose that's needed to maintain patient clear or almost clear. In this case, I shall say the reason in the beginning why I would continue methotrexate and biologics in combination together until the patient is a lot better. The reason for that is typically if you are adding a biologic to methotrexate in the first place, probably because the patient is not under very good control and some of our biologics may need also some lead time for their full efficacy to kick in. So that combination of methotrexate and a biologic together in the beginning of that transition just really helps the patient to be under good control.