title: Methotrexate Dosing Regimen for Plaque-type Psoriasis: A Systematic Review of the Use of Test-dose, Start-dose, Dosing Scheme, Dose Adjustments, Maximum Dose and Folic Acid Supplementation.
abstract: There is a range of methotrexate dosing regimens for psoriasis. This review summarizes the evidence for test-dose, start-dose, dosing scheme, dose adjustments, maximum dose and use of folic acid. A literature search for randomized controlled trials and guidelines was performed. Twenty-three randomized controlled trials (29 treatment groups) and 10 guidelines were included. Two treatment groups used a test-dose, 5 guidelines recommend it. The methotrexate start-dose in randomized controlled trials varied from 5 to 25 mg/week, most commonly being either 7.5 mg or 15 mg. Guidelines vary from 5 to 15 mg/week. Methotrexate was administered as a single dose or in a Weinstein schedule in 15 and 11 treatment-groups, respectively; both recommended equally in guidelines. A fixed dose (n = 18), predefined dose (n = 3), or dose adjusted on clinical improvement (n = 8) was used, the last also being recommended in guidelines. Ten treatment groups used folic acid; in 2 it was allowed, in 14 not mentioned, and in 3 no folic acid was used. Most guidelines recommend the use of folic acid. Authors' suggestions for methotrexate dosing are given.
authors.affiliation: Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. s.p.menting@amc.uva.nl.
authors.forename: Stef P
authors.initials: SP
authors.lastname: Menting
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dekker
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Limpens
authors.forename: Lotty
authors.initials: L
authors.lastname: Hooft
authors.forename: Phyllis I
authors.initials: PI
authors.lastname: Spuls
mesh_terms: D019587:Dietary Supplements; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D004359:Drug Therapy, Combination; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D005492:Folic Acid; D008727:Methotrexate