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

Astrid M. Van Huizen; Stef P. Menting; Rolland Gyulai; Lars Iversen; Gayle E. Van Der Kraaij; Maritza A. Middelkamp-Hup; Richard B. Warren; Phyllis I. Spuls; the SPIN MTX Consensus Survey Study Group

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, Stef P. Menting, Rolland Gyulai, Lars Iversen, Gayle E. Van Der Kraaij, Maritza A. Middelkamp-Hup, Richard B. Warren, Phyllis I. Spuls, the SPIN MTX Consensus Survey Study Group

Malaysia Jeffrey Cheah Sch of Med & HS

Research output: Contribution to journal › Review Article › Research › peer-review

14 Citations (Scopus)

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..

Original language	English
Pages (from-to)	561-572
Number of pages	12
Journal	JAMA Dermatology
Volume	158
Issue number	5
DOIs	https://doi.org/10.1001/jamadermatol.2022.0434
Publication status	Published - May 2022

Access to Document

10.1001/jamadermatol.2022.0434

Cite this

Van Huizen, A. M., Menting, S. P., Gyulai, R., Iversen, L., Van Der Kraaij, G. E., Middelkamp-Hup, M. A., Warren, R. B., Spuls, P. I., & the SPIN MTX Consensus Survey Study Group (2022). International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis. JAMA Dermatology, 158(5), 561-572. https://doi.org/10.1001/jamadermatol.2022.0434

@article{74e443b00b714ed9b4b8a443c3aa8ae6,

title = "International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis",

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..",

author = "{Van Huizen}, {Astrid M.} and Menting, {Stef P.} and Rolland Gyulai and Lars Iversen and {Van Der Kraaij}, {Gayle E.} and Middelkamp-Hup, {Maritza A.} and Warren, {Richard B.} and Spuls, {Phyllis I.} and Schejtman, {Adri{\'a}n A.} and Alexander Egeberg and Alireza Firooz and Kumar, {Alur S.} and Amanda Oakley and Amy Foulkes and Ramos, {Andrea Machado Coelho} and Fougerousse, {Anne Claire} and Antoanela {\v C}arija and Ayse Akman-Karaka{\c s} and Barbara Horv{\'a}th and B{\'e}ata F{\'a}bos and Matlock, {Benjamin Hidalgo} and Clar{\'e}us, {Birgitta Wilson} and Carla Castro and Carlos Ferr{\'a}ndiz and Correa, {Carolina Cort{\'e}s} and Carolina Marchesi and Catherine Goujon and Cesar Gonzalez and C{\'e}sar Maldonado-Garc{\'i}a and Hong, {Chih Ho} and Griffiths, {Christopher E.M.} and Christian Vestergaard and Echeverr{\'i}a, {Christina Mariela} and {De La Cruz}, Claudia and Curdin Conrad and D{\'a}niel T{\"o}r{\H o}csik and Drvar, {Daniela Ledi{\'c}} and Deepak Balak and Denis Jullien and Diebrecht Appelen and Kim, {Dong Hyun} and {De Jong}, {Elke M.G.J.} and {El Gamal}, Emad and Emmanuel Laffitte and Emmanuel Mah{\'e} and Enik{\"o} Sonkoly and Colombo, {Erika P{\'a}ez} and Eva Vilarrasa and Fabienne Willaert and Novoa, {Farah D.} and Farhad Handjani and Fernando Valenzuela and Francisco V{\'i}lchez-M{\'a}rquez and Gonzalez, {Gabriela Otero} and G{\'a}sp{\'a}r Kriszti{\'a}n and Giovanni Damiani and Gordana Krnjevi{\'c}-Pezi{\'c} and Graciela Pellerano and Gregorio Carretero and Hunter, {Hamish J.A.} and Hassan Riad and Oon, {Hazel H.} and Boonen, {Hugo P.J.} and Moussa, {Iftin Osman} and Ignacio Garc{\'i}a-Doval and Ild{\'i}ko Cs{\'a}nyi and Ines Brajac and Irina Turchin and Ivan Grozdev and Weinberg, {Jeffrey M.} and Jenny Nicolopoulos and Jillian Wells and Lambert, {Jo L.W.} and Ingram, {John R.} and Prinz, {J{\"o}rg Christoph} and {De Souza Sittart}, {Jos{\'e} Alexandre} and Sanchez, {Jose Luis} and Hsiao, {Josephine Pa Fan} and Castro-Ayarza, {Juan Raul} and Maul, {Julia Tatjana} and {Van Den Reek}, {Juul M.P.A.} and Katarina Tr{\v c}ko and Kirk Barber and Kristian Reich and Gebauer, {Kurt Aaron} and Kuzma Khobzei and Maul, {Lara V.} and Massari, {Larisa Prpi{\'c}} and Laurence Fardet and {Le Cleach}, Laurence and Laurent Misery and Laxmisha Chandrashekar and Muresanu, {Lidia Irinel} and Lidian Lecluse and Lone Skov and Frez, {Ma Lorna} and Babi{\'c}, {Lucija Tomi{\'c}} and Llu{\'i}s Puig and Gomez, {Luis Castro} and M. Ramam and Maha Dutil and El-Sayed, {Mahira Hamdy} and Malgorzata Olszewska and Schram, {Mandy Elvira} and Franco, {Manuel Dario} and Mar Llamas-Velasco and Margarida Gon{\c c}alo and Vel{\'a}squez-Lopera, {Margarita M.} and Abad, {Maria Eugenia} and {De Oliveira}, {Maria De F{\'a}tima Santos Paim} and Seyger, {Marieke M.B.} and Marija Ka{\v s}telan and Marius Rademaker and Mariusz Sikora and Mark Lebwohl and Wiseman, {Marni C.} and Marta Ferran and {Van Doorn}, Martijn and Maryam Danespazhooh and Matilda Bylaitė-Bucinskiene and Gooderham, {Melinda J.} and Poli{\'c}, {Melita Vuk{\v s}i{\'c}} and {De Rie}, {Menno A.} and Min Zheng and Minerva G{\'o}mez-Flores and {Salleras I Redonnet}, Montse and Silverberg, {Nanette B.} and Nejib Doss and Nikhil Yawalkar and Olivier Chosidow and Omid Zargari and {De La Cueva}, Pablo and Pablo Fernandez-Pe{\~n}as and {C{\'a}rdenas Rojas}, {Paola J.} and Paolo Gisondi and Parbeer Grewal and Paul Sator and Luna, {Paula Carolina} and F{\'e}lix, {Paulo Antonio Oldani} and Paulo Varela and P{\'e}ter Holl{\'o} and Petra Cetkovska and Piergiacomo Calzavara-Pinton and Ghislain, {Pierre Dominique} and Araujo, {Raquel Ruiz} and Ricardo Romiti and R{\'o}bert Kui and Romana {\v C}eovi{\'c} and Ronald Vender and Lafuente-Urrez, {Rosario F{\'a}tima} and Rub{\'e}n Del-R{\'i}o and Gulin, {Sandra J.} and Sanjeev Handa and Mahil, {Satveer K.} and Kolalapudi, {Seetharam A.} and Marr{\'o}n, {Servando E.} and Azimi, {Seyyede Zeinab} and Janmohamed, {Sherief R.} and {Da Cruz Costa}, {Sidney Augusto} and Choon, {Siew Eng} and Slavomir Urbancek and Olusola Ayanlowo and Margasin, {Susana M.} and Wong, {Tak Wah} and Tarja M{\"a}lk{\"o}nen and Tatiana Hurtov{\'a} and Recin{\'e}, {Tatiana Riveros} and Theis Huldt-Nystr{\o}m and Tiago Torres and Liu, {Tong Yun} and Tsira Leonidze and Sharma, {Vinod Kumar} and Warren Weightman and Wayne Gulliver and Wendelien Veldkamp and {the SPIN MTX Consensus Survey Study Group}",

year = "2022",

month = may,

doi = "10.1001/jamadermatol.2022.0434",

language = "English",

volume = "158",

pages = "561--572",

journal = "JAMA Dermatology",

issn = "2168-6068",

publisher = "American Medical Association (AMA)",

number = "5",

}

Van Huizen, AM, Menting, SP, Gyulai, R, Iversen, L, Van Der Kraaij, GE, Middelkamp-Hup, MA, Warren, RB, Spuls, PI & the SPIN MTX Consensus Survey Study Group 2022, 'International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis', JAMA Dermatology, vol. 158, no. 5, pp. 561-572. https://doi.org/10.1001/jamadermatol.2022.0434

TY - JOUR

T1 - International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis

AU - Van Huizen, Astrid M.

AU - Menting, Stef P.

AU - Gyulai, Rolland

AU - Iversen, Lars

AU - Van Der Kraaij, Gayle E.

AU - Middelkamp-Hup, Maritza A.

AU - Warren, Richard B.

AU - Spuls, Phyllis I.

AU - Schejtman, Adrián A.

AU - Egeberg, Alexander

AU - Firooz, Alireza

AU - Kumar, Alur S.

AU - Oakley, Amanda

AU - Foulkes, Amy

AU - Ramos, Andrea Machado Coelho

AU - Fougerousse, Anne Claire

AU - Čarija, Antoanela

AU - Akman-Karakaş, Ayse

AU - Horváth, Barbara

AU - Fábos, Béata

AU - Matlock, Benjamin Hidalgo

AU - Claréus, Birgitta Wilson

AU - Castro, Carla

AU - Ferrándiz, Carlos

AU - Correa, Carolina Cortés

AU - Marchesi, Carolina

AU - Goujon, Catherine

AU - Gonzalez, Cesar

AU - Maldonado-García, César

AU - Hong, Chih Ho

AU - Griffiths, Christopher E.M.

AU - Vestergaard, Christian

AU - Echeverría, Christina Mariela

AU - De La Cruz, Claudia

AU - Conrad, Curdin

AU - Törőcsik, Dániel

AU - Drvar, Daniela Ledić

AU - Balak, Deepak

AU - Jullien, Denis

AU - Appelen, Diebrecht

AU - Kim, Dong Hyun

AU - De Jong, Elke M.G.J.

AU - El Gamal, Emad

AU - Laffitte, Emmanuel

AU - Mahé, Emmanuel

AU - Sonkoly, Enikö

AU - Colombo, Erika Páez

AU - Vilarrasa, Eva

AU - Willaert, Fabienne

AU - Novoa, Farah D.

AU - Handjani, Farhad

AU - Valenzuela, Fernando

AU - Vílchez-Márquez, Francisco

AU - Gonzalez, Gabriela Otero

AU - Krisztián, Gáspár

AU - Damiani, Giovanni

AU - Krnjević-Pezić, Gordana

AU - Pellerano, Graciela

AU - Carretero, Gregorio

AU - Hunter, Hamish J.A.

AU - Riad, Hassan

AU - Oon, Hazel H.

AU - Boonen, Hugo P.J.

AU - Moussa, Iftin Osman

AU - García-Doval, Ignacio

AU - Csányi, Ildíko

AU - Brajac, Ines

AU - Turchin, Irina

AU - Grozdev, Ivan

AU - Weinberg, Jeffrey M.

AU - Nicolopoulos, Jenny

AU - Wells, Jillian

AU - Lambert, Jo L.W.

AU - Ingram, John R.

AU - Prinz, Jörg Christoph

AU - De Souza Sittart, José Alexandre

AU - Sanchez, Jose Luis

AU - Hsiao, Josephine Pa Fan

AU - Castro-Ayarza, Juan Raul

AU - Maul, Julia Tatjana

AU - Van Den Reek, Juul M.P.A.

AU - Trčko, Katarina

AU - Barber, Kirk

AU - Reich, Kristian

AU - Gebauer, Kurt Aaron

AU - Khobzei, Kuzma

AU - Maul, Lara V.

AU - Massari, Larisa Prpić

AU - Fardet, Laurence

AU - Le Cleach, Laurence

AU - Misery, Laurent

AU - Chandrashekar, Laxmisha

AU - Muresanu, Lidia Irinel

AU - Lecluse, Lidian

AU - Skov, Lone

AU - Frez, Ma Lorna

AU - Babić, Lucija Tomić

AU - Puig, Lluís

AU - Gomez, Luis Castro

AU - Ramam, M.

AU - Dutil, Maha

AU - El-Sayed, Mahira Hamdy

AU - Olszewska, Malgorzata

AU - Schram, Mandy Elvira

AU - Franco, Manuel Dario

AU - Llamas-Velasco, Mar

AU - Gonçalo, Margarida

AU - Velásquez-Lopera, Margarita M.

AU - Abad, Maria Eugenia

AU - De Oliveira, Maria De Fátima Santos Paim

AU - Seyger, Marieke M.B.

AU - Kaštelan, Marija

AU - Rademaker, Marius

AU - Sikora, Mariusz

AU - Lebwohl, Mark

AU - Wiseman, Marni C.

AU - Ferran, Marta

AU - Van Doorn, Martijn

AU - Danespazhooh, Maryam

AU - Bylaitė-Bucinskiene, Matilda

AU - Gooderham, Melinda J.

AU - Polić, Melita Vukšić

AU - De Rie, Menno A.

AU - Zheng, Min

AU - Gómez-Flores, Minerva

AU - Salleras I Redonnet, Montse

AU - Silverberg, Nanette B.

AU - Doss, Nejib

AU - Yawalkar, Nikhil

AU - Chosidow, Olivier

AU - Zargari, Omid

AU - De La Cueva, Pablo

AU - Fernandez-Peñas, Pablo

AU - Cárdenas Rojas, Paola J.

AU - Gisondi, Paolo

AU - Grewal, Parbeer

AU - Sator, Paul

AU - Luna, Paula Carolina

AU - Félix, Paulo Antonio Oldani

AU - Varela, Paulo

AU - Holló, Péter

AU - Cetkovska, Petra

AU - Calzavara-Pinton, Piergiacomo

AU - Ghislain, Pierre Dominique

AU - Araujo, Raquel Ruiz

AU - Romiti, Ricardo

AU - Kui, Róbert

AU - Čeović, Romana

AU - Vender, Ronald

AU - Lafuente-Urrez, Rosario Fátima

AU - Del-Río, Rubén

AU - Gulin, Sandra J.

AU - Handa, Sanjeev

AU - Mahil, Satveer K.

AU - Kolalapudi, Seetharam A.

AU - Marrón, Servando E.

AU - Azimi, Seyyede Zeinab

AU - Janmohamed, Sherief R.

AU - Da Cruz Costa, Sidney Augusto

AU - Choon, Siew Eng

AU - Urbancek, Slavomir

AU - Ayanlowo, Olusola

AU - Margasin, Susana M.

AU - Wong, Tak Wah

AU - Mälkönen, Tarja

AU - Hurtová, Tatiana

AU - Reciné, Tatiana Riveros

AU - Huldt-Nystrøm, Theis

AU - Torres, Tiago

AU - Liu, Tong Yun

AU - Leonidze, Tsira

AU - Sharma, Vinod Kumar

AU - Weightman, Warren

AU - Gulliver, Wayne

AU - Veldkamp, Wendelien

AU - the SPIN MTX Consensus Survey Study Group

PY - 2022/5

Y1 - 2022/5

N2 - 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..

AB - 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..

UR - http://www.scopus.com/inward/record.url?scp=85128063342&partnerID=8YFLogxK

U2 - 10.1001/jamadermatol.2022.0434

DO - 10.1001/jamadermatol.2022.0434

M3 - Review Article

C2 - 35353175

AN - SCOPUS:85128063342

SN - 2168-6068

VL - 158

SP - 561

EP - 572

JO - JAMA Dermatology

JF - JAMA Dermatology

IS - 5

ER -

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

Abstract

Access to Document

Other files and links

Cite this