Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines
Abstract
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off‐label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off‐label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence‐ and consensus‐based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence‐ and consensus‐based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence‐ and consensus‐based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time‐honored medication.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Jun 14, 2023
- Source ID
- 10.1111/pde.15327
Entities
People
- A. Yasmine Kirkorian
- Abby S. Van Voorhees
- Adelaide A. Hebert
- Alan D. Irvine
- Amy S. Paller
- Austin M. Dalrymple
- Carsten Flohr
- Diane Hanna
- Dominic O. Co
- Elaine C Siegfried
- Heather A. Brandling‐bennett
- Irene Lara-Corrales
- Jeffrey P. Callen
- Jill Lindstrom
- Kelly M. Cordoro
- Ken B. Gordon
- Lara Wine Lee
- Leslie Castelo‐soccio
- Lisa M. Arkin
- Megan L. Curran
- Melissa Reyes
- Olivia M T Davies
- Ruth Ann Vleugels
- Susan Kim
- Wendy Smith Begolka
- Wynnis L. Tom
- Yvonne E Chiu
Organizations
- Boston Children's Hospital
- Center for Drug Evaluation and Research
- Children's Hospital Colorado
- Children's Hospital of Philadelphia
- Children's National Hospital
- Eastern Virginia Medical School
- George Washington University
- Harvard Medical School
- Medical College of Wisconsin
- Medical University of South Carolina
- National Eczema Association
- National Psoriasis Foundation
- Northwestern University
- Pediatric Dermatology Research Alliance
- Saint Louis University
- Seattle Children's
- Trinity College Dublin
- University of California, San Diego
- University of California, San Francisco
- University of Louisville
- University of Pennsylvania
- University of Texas Health Science Center at Houston
- University of Toronto
- University of Washington
- University of Wisconsin–Madison
- Walter Reed National Military Medical Center