Damiani Giovanni, Amerio Paolo, Bardazzi Federico, Carrera Carlo G, Conti Andrea, Cusano Francesco, Dapavo Paolo, DeSimone Clara, El Hachem May, Fabbrocini Gabriella, Gisondi Paolo, Loconsole Francesco, Micali Giuseppe, Neri Iria, Parodi Aurora, Piaserico Stefano, Romanelli Marco, Stingeni Luca, Pigatto Paolo D M
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Dermatol Ther (Heidelb). 2023 Jun;13(6):1219-1241. doi: 10.1007/s13555-023-00930-2. Epub 2023 May 21.
After decades of use, methotrexate displays an established safety and efficacy profile in both in-hospital and outpatient settings. Despite its widespread use, there is surprisingly little clinical evidence to guide daily practice with methotrexate in dermatology.
To provide guidance for clinicians in daily practice for areas in which there is limited guidance.
A Delphi consensus exercise on 23 statements was carried out on the use of methotrexate in dermatological routine settings.
Consensus was reached on statements that cover six main areas: (1) pre-screening exams and monitoring of therapy; (2) dosing and administration in patients naïve to methotrexate; (3) optimal strategy for patients in remission; (4) use of folic acid; (5) safety; and (6) predictors of toxicity and efficacy. Specific recommendations are provided for all 23 statements.
In order to optimize methotrexate efficacy, it is essential to optimize treatment using appropriate dosages, carrying out a rapid drug-based step-up on a treat-to-target strategy and preferably using the subcutaneous formulation. To manage safety aspects appropriately, it is essential to evaluate patients' risk factors and carry out proper monitoring during the course of treatment.
经过数十年的使用，甲氨蝶呤在住院和门诊环境中均显示出既定的安全性和有效性。尽管其使用广泛，但令人惊讶的是，在皮肤科领域，几乎没有临床证据可指导甲氨蝶呤的日常使用。
为临床医生在指导有限的领域提供日常实践指导。
针对甲氨蝶呤在皮肤科常规环境中的使用，就23条陈述开展了德尔菲共识达成活动。
就涵盖六个主要领域的陈述达成了共识：（1）治疗前筛查和监测；（2）初治甲氨蝶呤患者的给药；（3）缓解期患者的最佳策略；（4）叶酸的使用；（5）安全性；（6）毒性和疗效的预测因素。针对所有23条陈述均提供了具体建议。
为了优化甲氨蝶呤的疗效，必须使用适当剂量进行优化治疗，采用基于药物的快速逐步递增治疗至目标策略，最好使用皮下制剂。为了妥善管理安全问题，必须评估患者的风险因素并在治疗过程中进行适当监测。
