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Compare Methotrexate vs. Otezla

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Methotrexate and Otezla (apremilast) are both medications that can be used to treat psoriasis, but they have some important differences. Methotrexate is an antimetabolite, while Otezla is a phosphodiesterase-4 (PDE-4) inhibitor. Methotrexate is also used for various cancers and autoimmune conditions like rheumatoid arthritis, whereas Otezla is used for psoriatic arthritis and mouth sores from Behçet’s disease. Methotrexate is available as an oral tablet and an injection, while Otezla is only available as an oral tablet. Methotrexate is available as a generic, making it more affordable, while generic versions of Otezla are not expected until at least 2028. Common side effects of methotrexate include mouth sores and nausea, while Otezla often causes nausea and diarrhea. Methotrexate can interact with certain antibiotics and NSAIDs. Be sure your prescriber and pharmacist have a complete list of your medications.

  • Methotrexate (Trexall)
    Otezla (apremilast)
  • Methotrexate (Trexall)
    Otezla (apremilast)

  • Summary of Methotrexate vs. Otezla

    Summary for Antimetabolite
    Prescription only

    Methotrexate (Trexall) belongs to a drug class called antimetabolites. It’s used as chemotherapy at high doses to kill cancer cells and treat different cancers, such as acute lymphoblastic leukemia (ALL). At lower doses, methotrexate (Trexall) is considered a disease-modifying antirheumatic drug (DMARD) that treats certain non-cancer conditions, such as rheumatoid arthritis (RA). This medication is a tablet that you take by mouth. For most conditions, it’s taken once a week, but for some, it’s taken more often than that. Methotrexate (Trexall) side effects include mouth sores, nausea, and stomach upset.

    Summary for PDE-4 inhibitor
    Prescription only

    Otezla (apremilast) is a tablet that's taken by mouth. It's used to treat plaque psoriasis, psoriatic arthritis, and mouth sores from Behçet’s disease. This medication belongs to the drug class called phosphodiesterase-4 (PDE-4) inhibitors. You usually start Otezla (apremilast) at a low dose. Then, the dose is slowly raised over 5 days to lower the risk of side effects like nausea and diarrhea. This medication is available as a brand-name medication. Generic versions of apremilast likely won't be available until at least 2028.

  • Indications of Methotrexate vs. Otezla

    Indications for

    Cancer:

    •Acute lymphoblastic leukemia (ALL) in adults and children; given with other chemotherapy
    •Cutaneous T-cell lymphoma in adults; given by itself or with other chemotherapy
    •Advanced non-Hodgkin lymphoma in adults; given with other chemotherapy

    Non-cancer conditions:

    •Rheumatoid arthritis (RA) in adults
    •Polyarticular juvenile idiopathic arthritis (pJIA) in children
    •Severe psoriasis in adults
    Indications for
    •Active psoriatic arthritis in adults
    •Moderate-to-severe plaque psoriasis in people age 6 years and older weighing at least 44 lbs
    •Mouth sores from Behçet’s disease in adults

  • Pros and Cons of Methotrexate vs. Otezla

    Pros and Const for Antimetabolite
    Pros
    •Taken by mouth, so a good option for people who don’t like needles
    •A non-steroidal option for autoimmune conditions (e.g., rheumatoid arthritis, psoriasis)
    •Doesn’t typically cause hair loss or weight gain
    Cons
    •Might cause nausea and mouth sores
    •Can raise your risk for infection
    •Requires regular office visits and lab tests to check for serious side effects
    Pros and Const for PDE-4 inhibitor
    Pros
    •Taken by mouth
    •Can take with or without food
    •Dose adjustment available for people with severe kidney problems
    Cons
    •Dosing schedule can be confusing in the beginning
    •Common to have nausea or diarrhea in the beginning
    •Might not be a good option for people who've had depression or suicidal behavior

  • Common Side Effects of Methotrexate vs. Otezla

    Common Side Effects for
    •Mouth sores
    •Nausea or vomiting
    •Diarrhea
    •Stomach upset
    •Dizziness
    •Tiredness
    •Chills
    •Fever
    •Infection
    •Higher liver enzyme levels in the blood
    •Low white blood cells
    •Low platelet levels
    Common Side Effects for
    •Diarrhea (17%)
    •Nausea (17%)
    •Upper respiratory tract infection (e.g., common cold; 9%)
    •Headache (6%)

  • Warnings of Methotrexate vs. Otezla

    Common Side Effects for
    •Harm to unborn baby
    •Allergic reaction
    •Low blood cell counts
    •Damage to the digestive tract
    •Liver damage
    •Lung problems
    •Serious skin problems (including skin burns)
    •Kidney damage
    •Risk of serious side effects with dosing errors
    •Effect on folic acid levels in the body
    •Serious infections
    •Serious nervous system problems
    •Risk for new cancers
    •Tumor lysis syndrome
    •Changes to your ability to have children (infertility)
    •Higher risk for side effects if you have extra body fluid
    Common Side Effects for
    •Allergic reaction
    •Diarrhea, nausea, and vomiting
    •Depression
    •Possible weight loss
    •Drug interactions

  • Prices with our coupons for Methotrexate vs. Otezla

    Learn more about Methotrexate
    Learn more about Otezla

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