title: Methotrexate in Moderate to Severe Psoriasis: Review of the Literature and Expert Recommendations.
abstract: Methotrexate (MTX) is the most frequently used conventional systemic drug in the treatment of psoriasis. Despite over 50years of experience in this setting, certain aspects of the use of this drug in clinical practice are still little standardized and poorly understood. For this reason, a group of 15 experts took part in a consensus development conference to achieve consensus on a series of recommendations on the use of MTX in psoriasis. The guidelines, which were developed on the basis of a systematic review of the literature, were validated by 2 rounds of voting and categorized by level of evidence and grade of recommendation. Before MTX can be used to treat moderate to severe psoriasis, the patient must be evaluated to assess the suitability of the treatment, including consideration of vaccination status and screening for tuberculosis and pregnancy. The recommended starting dose for a patient with no risk factors is 10 to 20mg/wk, the therapeutic dose for most patients is 15mg/wk, and the maximum dose is 20mg/wk. Most patients who respond to treatment will show improvement within 8weeks. Parenteral administration of MTX is desirable when there is a risk of erroroneous dosing, nonadherence, gastrointestinal intolerance, or inadequate response to the therapeutic dose taken orally. Noninvasive methods are preferred for monitoring hepatotoxicity. MTX is a good treatment option for patients with a history of cancer, but is not recommended in patients with chronic hepatitisB infection or individuals who are seropositive for human immunodeficiency virus.
authors.affiliation: Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Electronic address: jmcarrascosac@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Carrascosa
authors.affiliation: Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: de la Cueva
authors.affiliation: Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: M
authors.initials: M
authors.lastname: Ara
authors.affiliation: Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: L
authors.initials: L
authors.lastname: Puig
authors.affiliation: Servicio de Dermatología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
authors.forename: X
authors.initials: X
authors.lastname: Bordas
authors.affiliation: Servicio de Dermatología, Hospital Universitario Gran Canaria Doctor Negrín , Las Palmas de Gran Canaria, España.
authors.forename: G
authors.initials: G
authors.lastname: Carretero
authors.affiliation: Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: L
authors.initials: L
authors.lastname: Ferrándiz
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Sánchez-Carazo
authors.affiliation: Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Daudén
authors.affiliation: Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors.forename: J L
authors.initials: JL
authors.lastname: López-Estebaranz
authors.affiliation: Servicio de Dermatología, Hospital Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, España.
authors.forename: D
authors.initials: D
authors.lastname: Vidal
authors.affiliation: Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: Herranz
authors.affiliation: Servicio de Dermatología, Complejo Hospitalario de Huelva, Huelva, España.
authors.forename: E
authors.initials: E
authors.lastname: Jorquera
authors.affiliation: Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: P
authors.initials: P
authors.lastname: Coto-Segura
authors.affiliation: Servicio de Dermatología, Hospital Universitari de Sabadell - Corporació Parc Taulí, Sabadell, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Ribera
mesh_terms: D000075202:Contraindications; D015658:HIV Infections; D019694:Hepatitis B, Chronic; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D009369:Neoplasms; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D008727:Methotrexate
keywords: Conferencia de consenso; Consensus development conference; Methotrexate; Metotrexato; Psoriasis