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. 2022 May 1;158(5):561-572.
doi: 10.1001/jamadermatol.2022.0434.

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis

Astrid M van Huizen  1 , Stef P Menting  2 , Rolland Gyulai  3 , Lars Iversen  4 , Gayle E van der Kraaij  1 , Maritza A Middelkamp-Hup  1 , Richard B Warren  5 , Phyllis I Spuls  1 ; SPIN MTX Consensus Survey Study Group; Adrián A Schejtman  6 , Alexander Egeberg  7 , Alireza Firooz  8 , Alur S Kumar  9 , Amanda Oakley  10 , Amy Foulkes  5 , Andrea Machado Coelho Ramos  11 , Anne-Claire Fougerousse  12 , Antoanela Carija  13 , Ayse Akman-Karakas  14 , Barbara Horváth  15 , Béata Fábos  16 , Benjamin Hidalgo Matlock  17 , Birgitta Wilson Claréus  18 , Carla Castro  19 , Carlos Ferrándiz  20 , Carolina Cortés Correa  21   22 , Carolina Marchesi  23 , Catherine Goujon  24 , Cesar Gonzalez  25 , César Maldonado-García  26 , Chih-Ho Hong  27 , Christopher E M Griffiths  5 , Christian Vestergaard  4 , Christina Mariela Echeverría  28 , Claudia de la Cruz  29 , Curdin Conrad  30 , Dániel Törocsik  31 , Daniela Ledic Drvar  32 , Deepak Balak  33 , Denis Jullien  34 , Diebrecht Appelen  35 , Dong Hyun Kim  36 , Elke M G J de Jong  35 , Emad El Gamal  37 , Emmanuel Laffitte  38 , Emmanuel Mahé  39 , Enikö Sonkoly  40 , Erika Páez Colombo  41 , Eva Vilarrasa  42 , Fabienne Willaert  43 , Farah D Novoa  44 , Farhad Handjani  45 , Fernando Valenzuela  46 , Francisco Vílchez-Márquez  47 , Gabriela Otero Gonzalez  48 , Gáspár Krisztián  31 , Giovanni Damiani  49   50 , Gordana Krnjevic-Pezic  51 , Graciela Pellerano  52 , Gregorio Carretero  53 , Hamish J A Hunter  5 , Hassan Riad  54 , Hazel H Oon  55 , Hugo P J Boonen  56 , Iftin Osman Moussa  57 , Ignacio García-Doval  58 , Ildíko Csányi  59 , Ines Brajac  60 , Irina Turchin  61   62   63 , Ivan Grozdev  64 , Jeffrey M Weinberg  65 , Jenny Nicolopoulos  66 , Jillian Wells  67 , Jo L W Lambert  33 , John R Ingram  68 , Jörg Christoph Prinz  69 , José Alexandre de Souza Sittart  70 , Jose Luis Sanchez  71 , Josephine Pa-Fan Hsiao  72 , Juan Raul Castro-Ayarza  73 , Julia-Tatjana Maul  74 , Juul M P A van den Reek  75 , Katarina Trcko  76 , Kirk Barber  77 , Kristian Reich  78 , Kurt Aaron Gebauer  79 , Kuzma Khobzei  80 , Lara V Maul  81 , Larisa Prpic Massari  82 , Laurence Fardet  83 , Laurence le Cleach  84   85 , Laurent Misery  86 , Laxmisha Chandrashekar  87 , Lidia Irinel Muresanu  88 , Lidian Lecluse  89 , Lone Skov  90   91 , Ma Lorna Frez  92 , Lucija Tomic Babic  93 , Lluís Puig  94 , Luis Castro Gomez  95 , M Ramam  96 , Maha Dutil  97 , Mahira Hamdy El-Sayed  98 , Malgorzata Olszewska  99 , Mandy Elvira Schram  100 , Manuel Dario Franco  101 , Mar Llamas-Velasco  102 , Margarida Gonçalo  103 , Margarita M Velásquez-Lopera  104 , Maria Eugenia Abad  105 , Maria de Fátima Santos Paim de Oliveira  106 , Marieke M B Seyger  107 , Marija Kaštelan  108 , Marius Rademaker  109 , Mariusz Sikora  110 , Mark Lebwohl  65 , Marni C Wiseman  111 , Marta Ferran  112 , Martijn van Doorn  113 , Maryam Danespazhooh  114 , Matilda Bylaite-Bucinskiene  115 , Melinda J Gooderham  116 , Melita Vukšic Polic  117 , Menno A de Rie  1 , Min Zheng  118 , Minerva Gómez-Flores  119 , Montse Salleras I Redonnet  120 , Nanette B Silverberg  65 , Nejib Doss  121 , Nikhil Yawalkar  122 , Olivier Chosidow  123 , Omid Zargari  124 , Pablo de la Cueva  125 , Pablo Fernandez-Peñas  126 , Paola J Cárdenas Rojas  127 , Paolo Gisondi  128 , Parbeer Grewal  129 , Paul Sator  130 , Paula Carolina Luna  131 , Paulo Antonio Oldani Félix  132 , Paulo Varela  133 , Péter Holló  134 , Petra Cetkovska  135 , Piergiacomo Calzavara-Pinton  136 , Pierre-Dominique Ghislain  137 , Raquel Ruiz Araujo  67 , Ricardo Romiti  138 , Róbert Kui  139 , Romana Ceovic  140 , Ronald Vender  141 , Rosario Fátima Lafuente-Urrez  142 , Rubén Del-Río  143 , Sandra J Gulin  144 , Sanjeev Handa  145 , Satveer K Mahil  146 , Seetharam A Kolalapudi  147 , Servando E Marrón  148   149 , Seyyede Zeinab Azimi  150 , Sherief R Janmohamed  151 , Sidney Augusto da Cruz Costa  152 , Siew Eng Choon  153 , Slavomir Urbancek  154 , Olusola Ayanlowo  155 , Susana M Margasin  156 , Tak-Wah Wong  157 , Tarja Mälkönen  158 , Tatiana Hurtová  159 , Tatiana Riveros Reciné  160 , Theis Huldt-Nystrøm  161 , Tiago Torres  162 , Tong-Yun Liu  163 , Tsira Leonidze  164 , Vinod Kumar Sharma  165 , Warren Weightman  166 , Wayne Gulliver  167 , Wendelien Veldkamp  168
Affiliations

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis

Astrid M van Huizen et al. JAMA Dermatol. .

Erratum in

  • Error in Figure 2.
    [No authors listed] [No authors listed] JAMA Dermatol. 2024 Feb 1;160(2):241. doi: 10.1001/jamadermatol.2023.5760. JAMA Dermatol. 2024. PMID: 38198172 Free PMC article. No abstract available.

Abstract

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.

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