Jawad Hassan AHMED, Sheima Nadim KADHİM, Khalil Ismael AL-HAMDİ

The effectiveness of Nigella sativa, methotrexate and their combination in the treatment of moderate to severe psoriasis

Amaç: Metotreksat (MTX) psöriazisli hastalarda sıklıkla kullanılan bir ilaçtır. Nigella sativa (NS - çörek otu)'nun vitiligo ve egzemada yaralı olduğu gösterilmiştir. Yakın zamanda NS'nin psöriatik lezyonları modifiye etmede etkin olduğu gösterildi. Bu çalışmanın amacı psöriazisde MTX+NS kombinasyonunun etkisini değerlendirmek ve bu etkinin NS ve MTX'in tek başına olan etkinliği ile karşılaştırmaktır.Yöntemler: Orta-ağır plak, palmoplantar ve guttat psöriazisli 60 hasta 12 haftalık çalışmaya alındı. Hastalar her grupta 20'şer hasta olacak şekilde 3 gruba ayrıldı. Grup 1'e günde 2 kez uygulanan NS merhemi (%20'lik)'ne ilaveten günde 3 kez 500 mg NS kapsülleri verildi. Grup 2 haftada bir 15 mg MTX tableti aldı ve Grup 3'e MTX+NS (Topikal ve oral) verildi. Bulgular: NS, MTX ve NS+MTX gruplarında sırasıyla %60, %80 ve %90 cevap alındı. NS tedavisi ile oksidatif stres belirteci olan serum malondialdehid (sMDA) 4,39 ± 0,81 µmol/L'den 2,31 ± 0,72 µmol/L'ye düştü, ancak MTX ile sMDA'da hafif artış gözlendi. 12 haftalık MTX ve NS+MTX tedavilerini takiben sMDA 4.39 ± 0.67 µmol/L'den 3.49 ± 0.65 µmol/L'ye indi. Tedavilerin tümünde karaciğer enzimleri ve tam kan sayımlarında bir değişiklik gözlenmedi. NS iyi tolere edildi ve MTX'in yaptığı mide rahatsızlığını iyileştirici etkisi gözlendi.Sonuç: NS, MTX'in anti-psöriatik etkisini kuvvetlendirdi. Topikal ve oral NS kullanımı orta ve ağır psöriazisde etkin ve güvenlidir.

Orta ve ağır psoriazis tedavisinde Nigella sativa, metotreksat ve ikisinin kombinasyonlarının etkinliği

Objective: Methotrexate (MTX) is a commonly prescribed drug for patients with psoriasis. Nigella sativa (NS) has been shown beneficial in vitiligo and in eczema. Recently, NS has shown activity in modifying psoriatic lesions. The aim of this study was to evaluate the effect of the combination (NS+MTX) on psoriasis and to compare that with NS or MTX monotherapy. Methods: Sixty patients with moderate to severe plaque, palmoplantar and guttate psoriasis were enrolled for 12 weeks study. The patients were divided into 3 groups; 20 patients in each. Group 1 was treated with NS ointment (20% w/w) 2 times daily + 500 mg NS capsule 3 times daily. Group 2 received MTX tablets 15 mg weekly and group 3 received MTX + NS (topical + oral). Results: Marked response was achieved in 60%, 80%, and 90% of patients on NS, MTX, and (NS + MTX) respectively. The respective relapse rate was 33.3%, 56.3%, and 27.8%. Serum malondialdehyde (sMDA), a parameter of oxidative stress was decreased from 4.39 ± 0.81 to 2.31 ± 0.72 µmol/L with NS treatment while a small increase in sMDA was observed with MTX. NS + MTX treatment reduced sMDA from 4.39 ± 0.67 to 3.49 ± 0.65 µmol/L after 12 weeks treatment. All treatments did not change liver enzymes or complete blood count. NS was well tolerated and showed ability in ameliorating gastric upset of MTX. Conclusion: NS augments antipsoriatic effect of MTX. Topical and oral use of NS is effective and safe in moderate to severe psoriasis.

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