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.
