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

SPIN MTX Consensus Survey Study Group, 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, Adrián A Schejtman, Alexander Egeberg, Alireza Firooz, Alur S Kumar, Amanda Oakley, Amy Foulkes, Andrea Machado Coelho Ramos, Anne-Claire Fougerousse, Antoanela Carija, Ayse Akman-Karakas, Barbara HorváthBéata Fábos, Benjamin Hidalgo Matlock, Birgitta Wilson Claréus, Carla Castro, Carlos Ferrándiz, Carolina Cortés Correa, Carolina Marchesi, Catherine Goujon, Cesar Gonzalez, César Maldonado-García, Chih-Ho Hong, Christopher E M Griffiths, Christian Vestergaard, Christina Mariela Echeverría, Claudia de la Cruz, Curdin Conrad, Dániel Törocsik, Daniela Ledic Drvar, Deepak Balak, Denis Jullien, Diebrecht Appelen, Dong Hyun Kim, Elke M G J de Jong, Emad El Gamal, Emmanuel Laffitte, Emmanuel Mahé, Enikö Sonkoly, Erika Páez Colombo, Eva Vilarrasa, Fabienne Willaert, Sherief R Janmohamed

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


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 languageEnglish
Pages (from-to)561-572
Number of pages12
JournalJAMA dermatology
Issue number5
Early online date2022
Publication statusPublished - 1 May 2022


  • International eDelphi Study
  • Methotrexate Dosing Regimen
  • Patients
  • Psoriasis


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