Difference Between Otezla Vs Methotrexate For Psoriasis

Otezla Vs Methotrexate For Psoriasis: Otezla and Methotrexate are both effective psoriasis treatments, but with different approaches. Otezla, a newer oral medication, targets a specific immune pathway, offering a more targeted and potentially gentler option with fewer side effects. Methotrexate, a traditional injectable drug, suppresses the entire immune system, leading to stronger but potentially harsher side effects. Ultimately, the choice depends on individual factors like severity, tolerability, and desired treatment approach. Both require close medical supervision and may not work for everyone.

Difference Between Otezla and Methotrexate

Both otezla which is also known as apremilast and methotrexate are medicines used to treat psoriasis, although they belong to different pharmaceutical classes and have different mechanisms of action. outlined are some important differences between Otezla and methotrexate for psoriasis.




Mechanism of Action

PDE4 Inhibitor



Oral Tablets

Oral or Injection

Treatment Target

Moderate to Severe Plaque Psoriasis in Adults

Psoriasis, Rheumatoid Arthritis, Psoriatic Arthritis, and other autoimmune conditions

Pregnancy and Breastfeeding

Category C (Risk cannot be ruled out), Safety during breastfeeding not established

Contraindicated during pregnancy (Category X), Not recommended during breastfeeding

Monitoring Requirements

Typically minimal laboratory monitoring

Regular blood tests for liver function and blood counts

Onset of Action

Several weeks for noticeable improvement

Few weeks to months for noticeable effects

Side Effects

Diarrhea, Nausea, Headache

Liver toxicity, Bone marrow suppression, Pulmonary complications, etc.


Hypersensitivity to apremilast or its components

Significant liver or kidney dysfunction, Pre-existing blood disorders, Active infections

Drug Interactions

Fewer interactions compared to methotrexate

Numerous potential interactions, Caution needed with certain medications


Tends to be more expensive

Generally more cost-effective (available in generic form)



Psoriasis and various autoimmune conditions

Prescription Medications

Requires prescription

Requires prescription

Systemic Treatment



Long-Term Use



Potential for Adverse Reactions



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What is Otezla?

Otezla is a prescription medication used to treat moderate-to-severe plaque psoriasis in adults. It plays a role by targeting specific immune cells involved in the inflammatory process of psoriasis, which helps to reduce redness, scaling, and itching. Otezla is a different type of medication than traditional psoriasis treatments like steroids or biologics, and it may be suitable for people who haven't responded well to other options.

Key Features of Otezla:

  • Mechanism of Action: PDE4, an enzyme implicated in inflammatory responses, is targeted. Otezla lowers inflammation and increases cell development by decreasing PDE4.
  • Administration: Taken orally twice a day, with or without meals.
  • Nausea, diarrhoea, headache, upper respiratory tract infections, and exhaustion are typical side effects, however they are usually minor and transitory. Severe adverse effects are uncommon.
  • Advantages: When compared to methotrexate, it is generally well-tolerated and has a lower risk of major adverse effects. It can be utilised in people who are unable to tolerate methotrexate.

What is Methotrexate?

Methotrexate is a medication used to treat a variety of conditions, including psoriasis, rheumatoid arthritis, and certain cancers. In psoriasis, it works by suppressing the overactive immune system that contributes to the development of skin lesions. Methotrexate is a powerful medication with potential side effects, so it's important to be monitored by a doctor while taking it.

Key Features of Methotrexate:

  • Mechanism of Action: Suppresses the immune system, preventing the hyperactive immune response that contributes to autoimmune disease inflammation.
  • Can be given orally, subcutaneously or intramuscularly injected, or administered intravenously. The dosage and frequency of administration differ based on the ailment being treated.
  • Nausea, vomiting, exhaustion, hair loss, mouth sores, liver damage, lung damage, and an increased risk of infection are more prevalent and possibly severe than with Otezla.
  • Benefits: Highly effective for many inflammatory disorders; frequently used as first-line therapy. In comparison to other modern drugs, it is quite inexpensive.

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Similarities Between Otezla and Methotrexate

  • Indications: Both Otezla and methotrexate are used to treat psoriasis.
  • Medications on Prescription: Both medications require a prescription from a healthcare provider.
  • Otezla and methotrexate are both systemic therapies, meaning they impact the entire body.
  • Long-Term Use: Depending on the particular patient's reaction and tolerance, both medicines may be taken for long-term psoriasis therapy.
  • Adverse responses: Because both medications have the potential for adverse responses, their usage should be closely monitored by healthcare professionals.

While both Otezla and Methotrexate are effective therapies for psoriasis and psoriatic arthritis, their mechanisms of action, side effects, and routes of administration are fundamentally different. Otezla, a PDE4 inhibitor, specifically targets inflammatory pathways within immune cells, providing a more tailored treatment with perhaps fewer adverse effects. Methotrexate, an immunosuppressant, suppresses the immune system as a whole, perhaps making it more effective in severe instances but also raising the risk of infections and other consequences. Furthermore, Otezla is administered orally, whereas Methotrexate is normally administered by injections or infusions, which affects patient experience and adherence. Finally, the decision between Otezla and Methotrexate is influenced by individual characteristics such as illness severity, patient preference, and possible dangers. Consultation with a healthcare practitioner is essential for identifying the best treatment plan.


What are Otezla and Methotrexate used for in treating skin conditions?

Otezla and Methotrexate are both medications prescribed for skin conditions such as psoriasis and psoriatic arthritis. Otezla is an oral medication that targets specific immune responses, while Methotrexate is a disease-modifying antirheumatic drug (DMARD) that works by suppressing the immune system.

How do the mechanisms of action differ between Otezla and Methotrexate?

Otezla works by inhibiting an enzyme called phosphodiesterase 4 (PDE4), which reduces inflammation in the body. On the other hand, Methotrexate interferes with the synthesis of DNA, RNA, and proteins, ultimately suppressing the immune system's activity.

Are there any similarities in the side effects of Otezla and Methotrexate?

Both medications may cause common side effects such as nausea, diarrhea, and headache. However, specific side effects can vary, with Otezla having its unique set of potential adverse reactions, and Methotrexate having others.

Can Otezla and Methotrexate be used together?

Combining Otezla and Methotrexate is not typically recommended unless specifically prescribed by a healthcare professional. It's crucial to consult with your doctor to discuss potential interactions and assess the risks and benefits.

Do Otezla and Methotrexate have any contraindications or specific patient groups they are not recommended for?

Both medications have certain contraindications and may not be suitable for everyone. Otezla is not recommended for patients with certain pre-existing conditions, while Methotrexate is generally avoided in pregnant women and individuals with liver or kidney issues.

What is the difference in administration between Otezla and Methotrexate?

Otezla is an oral medication taken in tablet form, while Methotrexate is available in various forms, including oral tablets and injections. The choice of administration depends on the patient's preference, medical condition, and the doctor's recommendation.