Methotrexate dosing regimen for plaque-type psoriasis: an update of a systematic review

BACKGROUND: Methotrexate (MTX) is a systemic treatment for plaque-type psoriasis. At the time of approval, no dose-ranging studies were performed. Nowadays, a uniform dosing regimen is lacking. This might contribute to suboptimal treatment with the drug. OBJECTIVE: To summarize the literature involving the MTX dosing regimens in psoriasis patients. METHODS: In this SR, RCTs and documents with aggregated evidence (AgEv) on the MTX dosing regimen in psoriasis were summarized. All randomized controlled trials (RCTs) in which oral, subcutaneous or intramuscular MTX was used in patients with psoriasis and AgEv, were included. The MEDLINE, EMBASE and CENTRAL databases were searched up to June 20, 2022. This SR was registered in PROSPERO. One guideline recommended a test dose, in other aggregated evidence a test dose was not mentioned or even discouraged. CONCLUSIONS: There is a lack of high-quality evidence and available data for dosing MTX in psoriasis is heterogeneous.