[Skip to Navigation]
Consensus Statement
March 30, 2022

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

Author Affiliations
  • 1Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
  • 2Department of Dermatology, OLVG, Amsterdam, the Netherlands
  • 3Department of Dermatology, University of Pécs, Medical School, Venerology and Oncodermatology, Pécs, Hungary
  • 4Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
  • 5The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
JAMA Dermatol. 2022;158(5):561-572. doi:10.1001/jamadermatol.2022.0434
Key Points

Question  Can consensus be reached on the dosing of methotrexate in treating patients with psoriasis?

Findings  In this consensus statement, after a systematic review of the literature, 21 proposals were formulated involving methotrexate dosing in adults, children, and vulnerable patients. On 20 of these proposals, consensus was reached in 3 eDelphi survey rounds and an online consensus meeting.

Meaning  The findings of this study suggest that this consensus can be used in guideline documents as well as further optimization of methotrexate treatment in patients with psoriasis.


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.

Add or change institution