International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis
Astrid M. van Huizen, S.P. Menting, Rolland Gyulai, Lars Iversen, G. E. van der Kraaij, Maritza A. Middelkamp‐Hup, Richard B. Warren, Phyllis I. Spuls, SPIN MTX Consensus Survey Study Group, Adrián A. Schejtman, Alexander Egeberg, Alireza Firooz, Alur S. Kumar, Amanda Oakley, Amy Foulkes, Andréa Machado Coelho Ramos, Anne‐Claire Fougerousse, Antoanela Čarija, Ayşe Akman-Karakaş, Barbara Horváth, Beáta Fábos, Benjamín Hidalgo Matlock, Birgitta Wilson Claréus, Carla Castro, Carlos Ferrándiz, Carolina Cortés Correa, Carolina Marchesi, C. Goujon, Cèsar Gonzàlez, César Maldonado-García, Chih-ho Hong, C.E.M. Griffiths, Christian Vestergaard, Christina Mariela Echeverría, Claudia de la Cruz, Curdin Conrad, Dániel Törőcsik, Daniela Ledić Drvar, Deepak Balak, D. Jullien, Diebrecht Appelen, Dong Hyun Kim, E.M.G.J. de Jong, Emad El Gamal, Emmanuel Laffitte, E. Mahé, Enikö Sonkoly, Erika Páez Colombo, Eva Vilarrasa, Fabienne Willaert, Farah Novoa, Farhad Handjani, Fernando Valenzuela, Francisco Vílchez‐Márquez, Gabriela Otero González, Krisztián Gáspár, Giovanni Damiani, Gordana Krnjević-Pezić, Graciela Pellerano, G. Carretero, H.J.A. Hunter, Hassan Riad, Hazel H. Oon, Hugo P.J. Boonen, Iftin Osman Moussa, I. García‐Doval, Ildíko Csányi, Ines Brajac, Irina Turchin, Ivan Grozdev, Jeffrey M Weinberg, Jenny Nicolopoulos, Jillian Wells, Jo Lambert, John R Ingram, Jörg C. Prinz, José Alexandre de Souza Sittart, José Luis Alfonso Sánchez, Josephine Pa-Fan Hsiao, Juan Raúl Castro‐Ayarza, Julia‐Tatjana Maul, J.M.P.A. van den Reek, Katarina Trčko, Kirk Barber, Kristian Reich, Kurt Gebauer, Kuzma Кhobzei, Lara Valeska Maul, Larisa Prpić Massari, L. Fardet, Laurence Le Cleach, L. Misery, Laxmisha Chandrashekar, Lidia Irinel Muresanu, L.L.A. Lecluse, Lone Skov, Ma. Lorna F. Frez, Lucija Tomić Babić, L. Puig, Luis Castro Gomez
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.