Psoriasis affects around 3% of people in the UK and can seriously impact daily life. Current treatments like methotrexate often don’t work well and come with side effects. New biologic injections, such as adalimumab, are far more effective but most patients with moderate psoriasis can’t access them because of strict eligibility rules.

This trial will compare adalimumab with methotrexate in people with moderate psoriasis (defined as a PASI score of more than 5 and less than 10.) to see which works better and which is more cost-effective. With biologics now much cheaper and easier to monitor than traditional drugs, this research could help update treatment guidelines and improve care for thousands of patients.

This study was shaped with input from people living with psoriasis. Patients told us that those with moderate disease often feel overlooked and want the option of earlier access to biologic treatments like adalimumab. They highlighted the burden of methotrexate - frequent blood tests, liver scans, and side effects such as nausea - and supported a simpler trial design without unnecessary complexity.

Currently, we know adalimumab works better than methotrexate for severe psoriasis (PASI ≥10), but there’s no evidence for moderate cases (PASI score of more than 5 and less than 10). If adalimumab proves more effective, using it earlier could transform lives, improving mental health, quality of life and reducing hospital visits.

With adalimumab now far more affordable and requiring less monitoring than methotrexate, our aim is to re-examine what’s best for patients. No trials have compared these treatments in moderate psoriasis, so this research will fill a critical gap and could lead to updated NHS guidelines