Toward More Uniform Methotrexate Dosing in Psoriasis | MedPage Today

Medpagetoday

Toward More Uniform Methotrexate Dosing in Psoriasis | MedPage Today"


Play all audios:

Loading...

With overwhelming support from some 200 experts worldwide, dosing of methotrexate (MTX) for psoriasis should start at 15 mg/week for most adults, though lower in those considered


"vulnerable" and in children, according to a new consensus statement.


That may not seem like big news, as it's in line with most dermatologists' and rheumatologists' practice. But in fact, surveys have shown wide variation in physicians' approach to MTX dosing


in psoriasis. The authors of the consensus statement, led by Astrid M. van Huizen, MD, of the University of Amsterdam, noted that some doctors prescribe as little as 5 mg/week or as much as


22 mg/week for initial dosing in adults.


"The variability in treatment regimens might have contributed to suboptimal treatment with MTX or early discontinuation of treatment because of limited efficacy or, in the case of


overtreatment, adverse effects," van Huizen and colleagues wrote in their statement, appearing in JAMA Dermatology.


Consequently, the Skin Inflammation and Psoriasis International Network (SPIN), comprising some 4,500 professionals in the field, asked its members to participate in a series of three


surveys about their beliefs and recommendations for methotrexate dosing. Just over 200 did so for the first round and 180 completed all three; 58 also participated in a consensus meeting


where proposals not achieving consensus through this process were discussed and refined further.


Seven SPIN leaders from Britain and continental Europe formed a working group to identify the main issues around MTX dosing that need standardization. They came up with seven topics -- test


dose, start dose, dosage adjustment, maximum dose, form of administration, switching formulations, and use of folic acid -- with consideration of how they might differ among adults,


"vulnerable patients," and children.


Proposed consensus statements included, for example: "Usually, MTX is administered in a single weekly dose," and "When starting MTX in vulnerable patients, start with a dosage of 7.5-10


mg/wk." In each survey round, participants rated their agreement with the statements on a nine-point scale: 1-3 indicated disagreement, 7-9 reflected agreement, and 4-6 was considered


neither agreeing nor disagreeing. Voters were asked to avoid the middle range whenever possible, as such votes would make it more difficult to achieve consensus.


At each round, participants could also propose their own new or reworded statements. In the end, 21 statements were brought forward to the third round, and 16 achieved what SPIN had defined


as consensus (no more than 15% of voters disagreeing).


Both of the two quoted above were agreed to. Others included: "Folic acid should be supplemented in all patients"; "Usually, MTX is administered orally"; and "In case of inefficacy or


insufficient effect, according to the treatment goals, it is preferred to switch the MTX route of administration from oral to subcutaneous."


Also achieving consensus were the preferred dosage for children ("around 10 mg/m2/wk"), more items on folic acid dosing, and a stipulation that efficacy shouldn't be assessed until patients


have been on the drug "at least 3-4" months.


Five proposals went to the consensus meeting for further discussion and voting, with four gaining consensus there. Two of these stated that test doses aren't needed for vulnerable patients


or children, respectively; one set the maximum weekly MTX dose at 25 mg for vulnerable patients, the same as for other adults; and the fourth called for folic acid to be given once weekly.


The one statement not achieving final consensus was, "The dosage of folic acid should be increased when increasing the dosage of MTX." Fully 93% of meeting participants disagreed with it,


which looks very much like consensus, but under SPIN's rules it had to be considered non-achieved.


This so-called eDelphi procedure had some limitations, van Huizen and colleagues noted. "Most participants were from Europe," the authors wrote, whereas the group had hoped to attract input


more widely. Their definition of consensus was somewhat arbitrary, and the focus on MTX and folic acid dosing meant that some related issues such as safety monitoring went unaddressed.


Perhaps most importantly, the agreed-upon statements are expert opinion, considered the weakest form of evidence for guidelines. SPIN leaders did link the proposals to published reports from


randomized trials, so they were founded to some extent on hard science. Nevertheless, the selections were not necessarily systematic or comprehensive.


Many of the roughly 200 authors reported relationships with pharmaceutical companies and other commercial entities.


Trending News

Aarp rewards - join free, earn & get rewarded

WHAT IS AARP REWARDS? AARP Rewards is a free loyalty program that rewards you for the things you do every day. Earn poin...

Flash acts as a co-activator of the transcription factor c-myb and localizes to active rna polymerase ii foci

ABSTRACT The c-Myb oncoprotein is a DNA-binding transcription factor with a key role in early stages of hematopoiesis. T...

Wango tango vs. Weenie roast: a scene-by-scene, act-by-act comparison

To Wango Tango or to Weenie Roast? That’s the question facing music fans on May 14, when two of Southern California’s mo...

Chelsea transfer news: dayot upamecano at top of thomas tuchel’s wish list

Chelsea are poised to join the race to sign Dayot Upamecano from RB Leipzig, according to reports. The in-demand centre-...

Umpire and referee records | Twenty20 Internationals | Cricinfo Statsguru | ESPNcricinfo.com

ESPN CricinfoLive ScoresLive Scores HomeScheduleResultsMonth viewSeason viewInternational calendarDesktop ScoreboardSeri...

Latests News

Toward More Uniform Methotrexate Dosing in Psoriasis | MedPage Today

With overwhelming support from some 200 experts worldwide, dosing of methotrexate (MTX) for psoriasis should start at 15...

"nothing but respect for eddie" - harry randall: england halfback expects tough challenge from jones' japan - ruck

ENGLAND COMMENCE THEIR FIRST OF THREE SUMMER FIXTURES THIS SATURDAY, AS THEY TAKE ON THE JAPAN OUT IN TOKYO. THE UNDERLY...

Outcome data for renal denervation: craving the unattainable?

From the outset, registries and studies consistently demonstrated the safety of catheter-based renal denervation (RDN); ...

Interior minister of thailand resigns

BANGKOK, Thailand — Thailand’s ruling party was dealt a sharp political blow Wednesday when its secretary-general, Sanan...

‘lost in hong kong,’ ’99 homes’ boast solid starts, ‘sicario’ fearsome in 2nd frame: specialty b. O.

In a competitive weekend for specialty movies, a couple of newcomers shined. Well Go USA opened _LOST IN HONG KONG_ in o...

Top