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International consensus on methotrexate dosing for patients with atopic dermatitis: An eDelphi study
Anouk G M Caron1,2, Astrid M van Huizen1,2, Annelie A H Musters1,2
1Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Summary
This study established international expert consensus on methotrexate (MTX) dosing for atopic dermatitis (AD). The findings provide standardized guidance for MTX treatment in both adults and children with AD.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Practice Guidelines
Background:
- Methotrexate (MTX) is widely used off-label for atopic dermatitis (AD).
- Limited high-quality evidence exists for optimal MTX dosing in AD.
- Current guidelines lack clear recommendations for MTX dosing strategies.
Purpose of the Study:
- To achieve international expert consensus on standardizing MTX dosing regimens for AD.
- To develop evidence-based recommendations for MTX treatment in adult and pediatric AD patients.
Main Methods:
- An electronic Delphi (eDelphi) study involving dermatologists experienced in MTX treatment for AD.
- Three online survey rounds informed by systematic literature review.
- Consensus defined as ≥70% agreement and <15% disagreement; unresolved issues addressed in a consensus meeting.
Main Results:
- 152 participants completed Round 1, with 104 completing all survey rounds.
- Consensus was reached on 19 proposals covering test dose, start dose, maximum dose, administration route, dosing schedule, treatment cessation, duration, and folic acid supplementation.
- Key areas of consensus include optimal MTX administration and supportive care for AD patients.
Conclusions:
- The eDelphi study successfully established consensus on 19 critical MTX dosing proposals for AD.
- These consensus-based recommendations aim to standardize global MTX use in AD.
- The findings will guide clinical decision-making for dermatologists treating AD with MTX.
