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

van Huizen AM 1 , Menting SP 2 , Gyulai R 3 , Iversen L 4 , van der Kraaij GE 1 , Middelkamp-Hup MA 1 Show all authors , Warren RB 5 , Spuls PI 1 , SPIN MTX Consensus Survey Study Group , Schejtman AA 6 , Egeberg A 7 , Firooz A 8 , Kumar AS 9 , Oakley A 10 , Foulkes A 5 , Ramos AMC 11 , Fougerousse AC 12 , Carija A 13 , Akman-Karakas A 14 , Horváth B 15 , Fábos B 16 , Matlock BH 17 , Claréus BW 18 , Castro C 19 , Ferrándiz C 20 , Correa CC 21 , Marchesi C 22 , Goujon C 23 , Gonzalez C 24 , Maldonado-García C 25 , Hong CH 26 , Griffiths CEM 5 , Vestergaard C 4 , Echeverría CM 27 , de la Cruz C 28 , Conrad C 29 , Törocsik D 30 , Drvar DL 31 , Balak D 32 , Jullien D 33 , Appelen D 34 , Kim DH 35 , de Jong EMGJ 34 , El Gamal E 36 , Laffitte E 37 , Mahé E 38 , Sonkoly E 39 , Colombo EP 40 , Vilarrasa E 41 , Willaert F 42 , Novoa FD 43 , Handjani F 44 , Valenzuela F 45 , Vílchez-Márquez F 46 , Gonzalez GO 47 , Krisztián G 30 , Damiani G 48 , Krnjevic-Pezic G 49 , Pellerano G 50 , Carretero G 51 , Hunter HJA 5 , Riad H 52 , Oon HH 53 , Boonen HPJ 54 , Moussa IO 55 , García-Doval I 56 , Csányi I 57 , Brajac I 58 , Turchin I 59 , Grozdev I 60 , Weinberg JM 61 , Nicolopoulos J 62 , Wells J 63 , Lambert JLW 32 , Ingram JR 64 , Prinz JC 65 , de Souza Sittart JA 66 , Sanchez JL 67 , Hsiao JP 68 , Castro-Ayarza JR 69 , Maul JT 70 , van den Reek JMPA 71 , Trcko K 72 , Barber K 73 , Reich K 74 , Gebauer KA 75 , Khobzei K 76 , Maul LV 77 , Massari LP 78 , Fardet L 79 , le Cleach L 80 , Misery L 81 , Chandrashekar L 82 , Muresanu LI 83 , Lecluse L 84 , Skov L 85 , Frez ML 86 , Babic LT 87 , Puig L 88 , Gomez LC 89 , Ramam M 90 , Dutil M 91 , El-Sayed MH 92 , Olszewska M 93 , Schram ME 94 , Franco MD 95 , Llamas-Velasco M 96 , Gonçalo M 97 , Velásquez-Lopera MM 98 , Abad ME 99 , de Oliveira MFSP 100 , Seyger MMB 101 , Kaštelan M 102 , Rademaker M 103 , Sikora M 104 , Lebwohl M 61 , Wiseman MC 105 , Ferran M 106 , van Doorn M 107 , Danespazhooh M 108 , Bylaite-Bucinskiene M 109 , Gooderham MJ 110 , Polic MV 111 , de Rie MA 1 , Zheng M 112 , Gómez-Flores M 113 , Salleras I Redonnet M 114 , Silverberg NB 61 , Doss N 115 , Yawalkar N 116 , Chosidow O 117 , Zargari O 118 , de la Cueva P 119 , Fernandez-Peñas P 120 , Cárdenas Rojas PJ 121 , Gisondi P 122 , Grewal P 123 , Sator P 124 , Luna PC 125 , Félix PAO 126 , Varela P 127 , Holló P 128 , Cetkovska P 129 , Calzavara-Pinton P 130 , Ghislain PD 131 , Araujo RR 63 , Romiti R 132 , Kui R 133 , Ceovic R 134 , Vender R 135 , Lafuente-Urrez RF 136 , Del-Río R 137 , Gulin SJ 138 , Handa S 139 , Mahil SK 140 , Kolalapudi SA 141 , Marrón SE 142 , Azimi SZ 143 , Janmohamed SR 144 , da Cruz Costa SA 145 , Choon SE 146 , Urbancek S 147 , Ayanlowo O 148 , Margasin SM 149 , Wong TW 150 , Mälkönen T 151 , Hurtová T 152 , Reciné TR 153 , Huldt-Nystrøm T 154 , Torres T 155 , Liu TY 156 , Leonidze T 157 , Sharma VK 158 , Weightman W 159 , Gulliver W 160 , Veldkamp W 161

Affiliations 

  • 1 Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
  • 2 Department of Dermatology, OLVG, Amsterdam, the Netherlands
  • 3 Department of Dermatology, University of Pécs, Medical School, Venerology and Oncodermatology, Pécs, Hungary
  • 4 Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
  • 5 The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
  • 6 Centro Dermatológico Schejtman, Provincia de Buenos Aires, Argentina
  • 7 Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
  • 8 Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
  • 9 Apollo Hospital, Secunderabad, Telangana, India
  • 10 Waikato District Health Board, University of Auckland, Auckland, New Zealand
  • 11 Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  • 12 Military Teaching Hospital Begin, Saint Mandé, France
  • 13 School of Medicine, University of Split, University Hospital Centre Split, Croatia
  • 14 Department of Dermatology and Venerology, Akdeniz University School of Medicine, Antalya, Turkey
  • 15 Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 16 Department of Dermatology, Teaching Hospital Kaposvar, Kaposvar, Hungary
  • 17 University of Costa Rica/Hospital Nacional de Niños, San Pedro Montes de Oca, San Jose Province, Costa Rica
  • 18 Psoriasis Treatment Wards, Stockholm, Sweden
  • 19 Dermatologist Hospital Universitario Austral, Buenos Aires, Argentina
  • 20 Department of Dermatology, Hospital universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain
  • 21 Dermatology Service of La Samaritana University Hospital, Bogotá, Colombia
  • 22 Proderma, Clínica de la piel, San Juan, Argentina
  • 23 Department of Immunology and Clinical Allergology, Lyon sud Hospital, Saint-Genis-Laval, France
  • 24 Private practice, Bogotá, Colombia
  • 25 Centro Dermatologico "Dr. Ladislao de la Pascua," Mexico City, Mexico
  • 26 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
  • 27 Instituto de Rehabilitación Psicofísica, IREP, Buenos Aires, Argentina
  • 28 Clinica Dermacross, Santiago, Chile
  • 29 Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
  • 30 Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  • 31 Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Croatia
  • 32 Department of Dermatology, Ghent University Hospital, Ghent, Belgium
  • 33 Hospices Civils de Lyon, Hôpital E. Herriot, Service de Dermatologie, Lyon, France
  • 34 Radboud University Medical Center, Nijmegen, the Netherlands
  • 35 Department of Dermatology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
  • 36 Damietta Faculty of Medicine, Al-Azhar University, Cairo, Egypt
  • 37 Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
  • 38 Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
  • 39 Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  • 40 Hospital Vargas de Caracas, Venezuela
  • 41 Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 42 Hôpital ERASME, Université Libre de Bruxelles, Anderlecht, Belgium
  • 43 Private practice, Santiago de Surco, Peru
  • 44 Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • 45 Department of Dermatology University of Chile and Centro Internacional de Estudios Clinicos, Probity Medical Research, Santiago, Chile
  • 46 Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
  • 47 Hospital de Clínicas. Universidad de la República Montevideo, Uruguay
  • 48 Department of Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
  • 49 NAFTALAN, Special Hospital for Medical Rehabilitation, Zagreb, Croatia
  • 50 SOARPSO, Argentina
  • 51 Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
  • 52 Hamad Medical Corporation, Qatar
  • 53 National Skin Centre, Singapore
  • 54 Heilig Hartziekenhuis, Leuven, Belgium
  • 55 Service de Dermatologie, Hôpital Cheiko, Djibouti
  • 56 Dermatology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
  • 57 Department of Dermatology and Allergology, Albert Szent-Györgyi Health Center, Department of Dermatology and Allergology, Szeged, Hungary
  • 58 Department of Dermatovenerology, University Hospital Clinic Rijeka, Croatia
  • 59 Brunswick Dermatology Center, Fredericton, New Brunswick, Canada
  • 60 Department of Dermatology, Brugmann University Hospital, Brussels, Belgium
  • 61 Icahn School of Medicine at Mount Sinai, New York, New York
  • 62 Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  • 63 University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
  • 64 Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, Wales
  • 65 Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
  • 66 Hospital do Servidor Publico Estadual de Sao Paulo, Brazil
  • 67 Department of Dermatology, General Hospital Valencia, Valencia, Spain
  • 68 Department of Dermatology, MacKay Memorial Hospital, Taipei City, Taiwan
  • 69 Universidad Militar, Colpsor, Colombia
  • 70 Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
  • 71 Department of Dermatology, Radboudumc, Nijmegen, the Netherlands
  • 72 Department of Dermatology and Venereal Diseases, University Medical Centre Maribor, Maribor, Slovenia
  • 73 University of Calgary, Calgary, Alberta, Canada
  • 74 Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany
  • 75 Fremantle Dermatology, Western Australia, Australia
  • 76 Kyiv Medical University, Medical Centre Khobzei Clinic, Kyiv, Ukraine
  • 77 Department of Dermatology, University Hospital of Basel, Basel, Switzerland
  • 78 Department of Dermatovenerology, Clinical Hospital Center Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
  • 79 Department of dermatology, Hôpital Henri Mondor, Creteil, France
  • 80 University Paris Est Créteil, Créteil, France
  • 81 Department of Dermatology, University Hospital of Brest, Department of Dermatology, Brest, France
  • 82 Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
  • 83 European Academy of Dermatology and Venereology member, Romania
  • 84 Bergman Clinics, Dermatology, Haarlem and Amsterdam
  • 85 Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
  • 86 University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
  • 87 Special Hospital for Medical Rehabilitation, Naftalan, Azerbaijan
  • 88 Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona School of Medicine, Barcelona, Spain
  • 89 Hospital Militar Central Universidad Militar Nueva Granada, Bogota, Colombia
  • 90 All India Institute of Medical Sciences, New Delhi, India
  • 91 University of Toronto, Toronto, Ontario, Canada
  • 92 Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • 93 Department of Dermatology, Medical Unversity of Warsaw, Warsaw, Poland
  • 94 ZBC Multicare, Hilversum, the Netherlands
  • 95 Universidad El Bosque, Bogotá, Colombia
  • 96 Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
  • 97 Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • 98 Universidad de Antioquia, Centro de Investigaciones Dermatológicas CIDERM, Medellín, Colombia
  • 99 Hospital Aleman and Hospital Ramos Mejia, Buenos Aires, Argentina
  • 100 Federal University of Bahia, Brazil
  • 101 Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
  • 102 Department of Dermatovenergology, Referral Center for Psoriasis, CHC Rijeka, University of Rijeka, Rijeka, Croatia
  • 103 Waikato Clinical School, School of Medicine, University of Auckland, Auckland, New Zealand
  • 104 National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
  • 105 Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  • 106 Department of Dermatology, Hospital del Mar, Barcelona, Spain
  • 107 Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
  • 108 Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
  • 109 Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
  • 110 SKiN Centre for Dermatology and Probity Medical Research, Queen's University, Peterborough, Ontario, Canada
  • 111 Osijek University Hospital, Faculty of Medicine, Osijek, Croatia
  • 112 School of Medicine, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
  • 113 Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
  • 114 Department of Dermatology, Hospital Sagrat Cor, Barcelona, Spain
  • 115 Golden Towers Médical Centre, Tunis, Tunisia
  • 116 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  • 117 Universités de Tours et Nantes, Créteil, France
  • 118 Skin Research Center, Tehran, Iran
  • 119 Dermatology Department, Hospital Unuversitario Infanta Leonor, Madrid, Spain
  • 120 Department of Dermatology, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
  • 121 National University of Colombia, Bogata, Colombia
  • 122 Section of Dermatology and Venereology, University of Verona, Verona, Italy
  • 123 University of Alberta, Edmonton, Alberta, Canada
  • 124 Department of Dermatology, Clinic Hietzing, Vienna, Austria
  • 125 Hospital Aleman, Buenos Aires, Argentina
  • 126 Departament of Dermatology, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
  • 127 Dermatology Department, Centro Hospitalar VN Gaia, Portugal
  • 128 Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest, Hungary
  • 129 Department of Dermatovenereology, Faculty of Medicine, Charles University, Prague, Czech Republic
  • 130 University of Brescia, Brescia, Italy
  • 131 Department of Dermatology UCL St-Luc, Brussels, Belgium
  • 132 Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
  • 133 Department of Dermatology and AllergologyAlbert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
  • 134 Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
  • 135 Dermatrials Research Inc, Hamilton, Ontario, Canada
  • 136 Hospital Reina Sofia, Tudela, Spain
  • 137 Hospital L´Esperit Sant, Santa Coloma de Gramenet, Spain
  • 138 Department of Dermatology, Ryhov County Hospital, Jonkoping, Sweden
  • 139 Department of Dermatology, Venereology & Leprology, Chandigarh, India
  • 140 St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, England
  • 141 GSL Medical College, Rajahmundry, Andhra Pradesh, India
  • 142 Dermatology Department, University Hospital Miguel Servet, Zaragoza, Spain
  • 143 Center for Research and Training in Skin Diseases and Leprosy, Tehran, Iran
  • 144 Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  • 145 Secretaria Municipal de Saúde de Natal, Brazil
  • 146 Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
  • 147 Department of Dermatology, F.D. Roosevelt Hospital, Banska Bystrica, Slovakia
  • 148 Dermatology Unit, Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
  • 149 Consultorios Integrados Rosio, Hospital I Carrasco Rosario, Argentina
  • 150 Departments of Dermatology, Biochemistry & Molecular Biology, Center of Applied Nanomedicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 151 Helsinki University Hospital, Skin and Allergy Hospital, Helsinki, Finland
  • 152 Jessenius Faculty of Medicine, Martin, Comenius University, Bratislava, Slovakia
  • 153 Faculty of Medicine, Universidad del Desarrollo Santiago de Chile, Santiago, Chile
  • 154 Hudpoliklinikken i Namsos, Norway
  • 155 Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
  • 156 First Affiliated Hospital of Kunming Medical University, Kunming, China
  • 157 Akad.N.Kipshidze Central University Clinic, Tbilisi, Georgia
  • 158 School of Medical Sciences and Research, Sharda University, Uttar Pradesh, India
  • 159 Queen Elizabeth Hospital, Woodville, South Australia, Australia
  • 160 Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
  • 161 Department of Dermatology, Radboudumc Nijmegen, Nijmegen, the Netherlands
JAMA Dermatol, 2022 May 01;158(5):561-572.
PMID: 35353175 DOI: 10.1001/jamadermatol.2022.0434

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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