In psoriasis, there is no prospective evaluation of the combination MTX-anti TNF alpha to help to maintain long-term efficacy for all anti TNF alpha. Long-term maintenance treatment with the combination of MTX and infliximab was reported in one small retrospective cohort study of psoriasis patients experiencing a loss of response to infliximab (55). In total 23 patients received as a rescue either azathioprine (5 patients) or weekly MTX (18 patients) (7.5 to 15 mg, average 11.66 mg) in combination with infliximab. After a mean follow up of 26.5 months, only 2 patients on MTX combination stopped infliximab for loss of response which is lower compared to the 50% loss of response observed with infliximab monotherapy (55).