ABSTRACT
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.
Subject(s)
Methotrexate , Psoriasis , Adult , Child , Consensus , Folic Acid , Humans , Psoriasis/therapy , Surveys and QuestionnairesABSTRACT
El liposarcoma es, en frecuencia, el segundo tumor maligno de partes blandas, luego del histiocitoma fibroso maligno. Sin embargo, su presencia en la neurofibromatosis, una genodermatosis con potencial maligno, no está debidamente documentada. Presentamos dos pacientes con NF 1 en los que apareció el liposarcoma, ambas personas jóvenes (17 y 29 años), con el tumor localizado en miembro inferior derecho. La evolución ha sido muy maligna en el caso 1, con metástasis y muerte, y atenuada en el caso 2, donde el diagnóstico más precoz y la terapéutica instituida (cirugía y quimioterapia) permitieron controlar la enfermedad (2 años de observación). Se enfatiza la presencia de liposarcoma en NF 1
Subject(s)
Humans , Male , Female , Adolescent , Adult , Liposarcoma/pathology , Neurofibromatoses/complications , Neurofibromatosis 1/complications , Neurofibromatosis 1/diagnosis , Neurofibromatosis 2/diagnosisABSTRACT
El liposarcoma es, en frecuencia, el segundo tumor maligno de partes blandas, luego del histiocitoma fibroso maligno. Sin embargo, su presencia en la neurofibromatosis, una genodermatosis con potencial maligno, no está debidamente documentada. Presentamos dos pacientes con NF 1 en los que apareció el liposarcoma, ambas personas jóvenes (17 y 29 años), con el tumor localizado en miembro inferior derecho. La evolución ha sido muy maligna en el caso 1, con metástasis y muerte, y atenuada en el caso 2, donde el diagnóstico más precoz y la terapéutica instituida (cirugía y quimioterapia) permitieron controlar la enfermedad (2 años de observación). Se enfatiza la presencia de liposarcoma en NF 1 (AU)
