A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide.
To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics.
Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience).
In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree.
Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients.
In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.
About The Expert
Astrid M van Huizen
Stef P Menting
Rolland Gyulai
Lars Iversen
Gayle E van der Kraaij
Maritza A Middelkamp-Hup
Richard B Warren
Phyllis I Spuls
Adrián A Schejtman
Alexander Egeberg
Alireza Firooz
Alur S Kumar
Amanda Oakley
Amy Foulkes
Andrea Machado Coelho Ramos
Anne-Claire Fougerousse
Antoanela Carija
Ayse Akman-Karakas
Barbara Horváth
Béata Fábos
Benjamin Hidalgo Matlock
Birgitta Wilson Claréus
Carla Castro
Carlos Ferrándiz
Carolina Cortés Correa
Carolina Marchesi
Catherine Goujon
Cesar Gonzalez
César Maldonado-García
Chih-Ho Hong
Christopher E M Griffiths
Christian Vestergaard
Christina Mariela Echeverría
Claudia de la Cruz
Curdin Conrad
Dániel Törocsik
Daniela Ledic Drvar
Deepak Balak
Denis Jullien
Diebrecht Appelen
Dong Hyun Kim
Elke M G J de Jong
Emad El Gamal
Emmanuel Laffitte
Emmanuel Mahé
Enikö Sonkoly
Erika Páez Colombo
Eva Vilarrasa
Fabienne Willaert
Farah D Novoa
Farhad Handjani
Fernando Valenzuela
Francisco Vílchez-Márquez
Gabriela Otero Gonzalez
Gáspár Krisztián
Giovanni Damiani
Gordana Krnjevic-Pezic
Graciela Pellerano
Gregorio Carretero
Hamish J A Hunter
Hassan Riad
Hazel H Oon
Hugo P J Boonen
Iftin Osman Moussa
Ignacio García-Doval
Ildíko Csányi
Ines Brajac
Irina Turchin
Ivan Grozdev
Jeffrey M Weinberg
Jenny Nicolopoulos
Jillian Wells
Jo L W Lambert
John R Ingram
Jörg Christoph Prinz
José Alexandre de Souza Sittart
Jose Luis Sanchez
Josephine Pa-Fan Hsiao
Juan Raul Castro-Ayarza
Julia-Tatjana Maul
Juul M P A van den Reek
Katarina Trcko
Kirk Barber
Kristian Reich
Kurt Aaron Gebauer
Kuzma Khobzei
Lara V Maul
Larisa Prpic Massari
Laurence Fardet
Laurence le Cleach
Laurent Misery
Laxmisha Chandrashekar
Lidia Irinel Muresanu
Lidian Lecluse
Lone Skov
Ma Lorna Frez
Lucija Tomic Babic
Lluís Puig
Luis Castro Gomez
M Ramam
Maha Dutil
Mahira Hamdy El-Sayed
Malgorzata Olszewska
Mandy Elvira Schram
Manuel Dario Franco
Mar Llamas-Velasco
Margarida Gonçalo
Margarita M Velásquez-Lopera
Maria Eugenia Abad
Maria de Fátima Santos Paim de Oliveira
Marieke M B Seyger
Marija Kaštelan
Marius Rademaker
Mariusz Sikora
Mark Lebwohl
Marni C Wiseman
Marta Ferran
Martijn van Doorn
Maryam Danespazhooh
Matilda Bylaite-Bucinskiene
Melinda J Gooderham
Melita Vukšic Polic
Menno A de Rie
Min Zheng
Minerva Gómez-Flores
Montse Salleras I Redonnet
Nanette B Silverberg
Nejib Doss
Nikhil Yawalkar
Olivier Chosidow
Omid Zargari
Pablo de la Cueva
Pablo Fernandez-Peñas
Paola J Cárdenas Rojas
Paolo Gisondi
Parbeer Grewal
Paul Sator
Paula Carolina Luna
Paulo Antonio Oldani Félix
Paulo Varela
Péter Holló
Petra Cetkovska
Piergiacomo Calzavara-Pinton
Pierre-Dominique Ghislain
Raquel Ruiz Araujo
Ricardo Romiti
Róbert Kui
Romana Ceovic
Ronald Vender
Rosario Fátima Lafuente-Urrez
Rubén Del-Río
Sandra J Gulin
Sanjeev Handa
Satveer K Mahil
Seetharam A Kolalapudi
Servando E Marrón
Seyyede Zeinab Azimi
Sherief R Janmohamed
Sidney Augusto da Cruz Costa
Siew Eng Choon
Slavomir Urbancek
Olusola Ayanlowo
Susana M Margasin
Tak-Wah Wong
Tarja Mälkönen
Tatiana Hurtová
Tatiana Riveros Reciné
Theis Huldt-Nystrøm
Tiago Torres
Tong-Yun Liu
Tsira Leonidze
Vinod Kumar Sharma
Warren Weightman
Wayne Gulliver
Wendelien Veldkamp
References
PubMed