International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis
Authors: van Huizen Astrid M. , Menting Stef P. , Gyulai Rolland , Iversen Lars , van der Kraaij Gayle E. , Middelkamp-Hup Maritza A. , Warren Richard B. , Spuls Phyllis I. ,   SPIN MTX Consensus Survey Study Group, Schejtman Adrián A. , Egeberg Alexander , Firooz Alireza , Kumar Alur S. , Oakley Amanda , Foulkes Amy , Ramos Andrea Machado Coelho , Fougerousse Anne-Claire , Čarija Antoanela , Akman-Karakaş Ayse , Horváth Barbara , Fábos Béata , Matlock Benjamin Hidalgo , Claréus Birgitta Wilson , Castro Carla , Ferrándiz Carlos , Correa Carolina Cortés , Marchesi Carolina , Goujon Catherine , Gonzalez Cesar , Maldonado-García César , Hong Chih-ho , Griffiths Christopher E.M. , Vestergaard Christian , Echeverría Christina Mariela , de la Cruz Claudia , Conrad Curdin , Törőcsik Dániel , Drvar Daniela Ledić , Balak Deepak , Jullien Denis , Appelen Diebrecht , Kim Dong Hyun , de Jong Elke M.G.J. , El Gamal Emad , Laffitte Emmanuel , Mahé Emmanuel , Sonkoly Enikö , Colombo Erika Páez , Vilarrasa Eva , Willaert Fabienne , Novoa Farah D. , Handjani Farhad , Valenzuela Fernando , Vílchez-Márquez Francisco , Gonzalez Gabriela Otero , Krisztián Gáspár , Damiani Giovanni , Krnjević-Pezić Gordana , Pellerano Graciela , Carretero Gregorio , Hunter Hamish J. A. , Riad Hassan , Oon Hazel H. , Boonen Hugo P.J. , Moussa Iftin Osman , García-Doval Ignacio , Csányi Ildíko , Brajac Ines , Turchin Irina , Grozdev Ivan , Weinberg Jeffrey M. , Nicolopoulos Jenny , Wells Jillian , Lambert Jo L.W. , Ingram John R. , Prinz Jörg Christoph , de Souza Sittart José Alexandre , Sanchez Jose Luis , Hsiao Josephine Pa-Fan , Castro-Ayarza Juan Raul , Maul Julia-Tatjana , van den Reek Juul M.P.A. , Trčko Katarina , Barber Kirk , Reich Kristian , Gebauer Kurt Aaron , Khobzei Kuzma , Maul Lara V. , Massari Larisa Prpić , Fardet Laurence , le Cleach Laurence , Misery Laurent , Chandrashekar Laxmisha , Muresanu Lidia Irinel , Lecluse Lidian , Skov Lone , Frez Ma. Lorna , Babić Lucija Tomić , Puig Lluís , Gomez Luis Castro , Ramam M. , Dutil Maha , El-Sayed Mahira Hamdy , Olszewska Malgorzata , Schram Mandy Elvira , Franco Manuel Dario , Llamas-Velasco Mar , Gonçalo Margarida , Velásquez-Lopera Margarita M. , Abad Maria Eugenia , de Oliveira Maria de Fátima Santos Paim , Seyger Marieke M. B. , Kaštelan Marija , Rademaker Marius , Sikora Mariusz , Lebwohl Mark , Wiseman Marni C. , Ferran Marta , van Doorn Martijn , Danespazhooh Maryam , Bylaitė-Bucinskiene Matilda , Gooderham Melinda J. , Polić Melita Vukšić , de Rie Menno A. , Zheng Min , Gómez-Flores Minerva , Salleras i Redonnet Montse , Silverberg Nanette B. , Doss Nejib , Yawalkar Nikhil , Chosidow Olivier , Zargari Omid , de la Cueva Pablo , Fernandez-Peñas Pablo , Cárdenas Rojas Paola J. , Gisondi Paolo , Grewal Parbeer , Sator Paul , Luna Paula Carolina , Félix Paulo Antonio Oldani , Varela Paulo , Holló Péter , Cetkovska Petra , Calzavara-Pinton Piergiacomo , Ghislain Pierre-Dominique , Araujo Raquel Ruiz , Romiti Ricardo , Kui Róbert , Čeović Romana , Vender Ronald , Lafuente-Urrez Rosario Fátima , del-Río Rubén , Gulin Sandra J. , Handa Sanjeev , Mahil Satveer K. , Kolalapudi Seetharam A. , Marrón Servando E. , Azimi Seyyede Zeinab , Janmohamed Sherief R. , da Cruz Costa Sidney Augusto , Choon Siew Eng , Urbancek Slavomir , Ayanlowo Olusola , Margasin Susana M. , Wong Tak-Wah , Mälkönen Tarja , Hurtová Tatiana , Reciné Tatiana Riveros , Huldt-Nystrøm Theis , Torres Tiago , Liu Tong-Yun , Leonidze Tsira , Sharma Vinod Kumar , Weightman Warren , Gulliver Wayne , Veldkamp Wendelien 
Published: March 2022

Importance

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.

Objective

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.

Design, Setting, and Participants

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).

Main Outcomes and Measures

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.

Results

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.

Conclusions and Relevance

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.