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.
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.
Acta dermato venereologica