The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review

Figures & data

Figure 1. PRISMA 2020 flow diagram.

Table 1. RCTs, MTX dosing regimens.

	Adults				Children
MTX dosing aspect	Gerbens et al., the Netherlands^a (15)	Goujon et al., France (30)	Roekevisch et al., the Netherlands^a (18)	Schram et al., the Netherlands (16)	El-Khalawany et al., Egypt (29)
Test dose	5 mg	–	5 mg	5 mg	5 mg
Start dose	10 mg/wk	15 mg/wk	10 mg/wk	10 mg/wk	7.5 mg/wk
Maintenance dose, mean	–	15 or 25 mg/wk^b	14.5 mg/wk (yr 2)	20 mg/wk (wk 12) 17.5 mg/wk (wk 24)	7.5 mg/wk
Maximum dose	22.5 mg/wk	25 mg/wk	22.5 mg/wk	22.5 mg/wk	7.5 mg/wk
Administration form	Oral	Oral	Oral	Oral	Oral
Switch from oral to subcutaneous in case of GI complaints	–	–	–	–	–
Dosing scheme	Once a week	Once a week	Once a week	Once a week	Divided over 3 doses every 12 hrs
Folic acid supplementation	5 mg/wk, once weekly, one day after MTX intake	5 mg/day except on the day of MTX intake	5 mg/wk, once weekly, one day after MTX intake	5 mg/wk, once weekly, one day after MTX intake	400 μg/wk, once weekly, one day after MTX intake

Notes. Hyphens are written if something was not mentioned in the article. Hrs: hours; MTX: methotrexate; RCT: randomized controlled trial; wk: week; yr: year.

^aThese are follow-up studies from Schram et al. (16).

^bAfter eight weeks of treatment with 15 mg/week, the dose was increased to 25 mg/week for 16 more wks in 65% of the patients (who did not achieve 50% reduction in the SCORing Atopic Dermatitis (SCORAD) index).

Table 2. The most commonly cited recommendations from 21 guidelines regarding MTX dosing for adults and children with AD.

MTX dosing aspect	Adults	Children
Test dose	Recommended by 1 out of 16 guidelines (51)	Recommended by 1 out of 18 guidelines (51)
Start dose	5–15 mg/wk (7,47,60,61)	10–15 mg/m^2/wk (7,47,48,60)
Maintenance dose	7.5–25 mg/wk (19,46,53,54)	0.2–0.7 mg/kg/wk (45,50,53,54)
Maximum dose	25 mg/wk (8,47,61)	25 mg/wk (8,47,55,59,61)
Administration form	Oral or subcutaneous (6,8,43,51,55,61)	Oral or subcutaneous (6,8,43,48,51,59,61)
Switch from oral to subcutaneous in case of GI complaints	Recommended by 3 out of 14 guidelines (6,8,55)	Recommended by 2 out of 15 guidelines (6,55)
Dosing scheme	Once a week (6,8,45,51,55,56,61)	Once a week (6,50,51,55,56)
Folic acid supplementation	Recommended by 7 out of 16 guidelines (6,43,46,51,55,56,61)	Recommended by 8 out of 18 guidelines (6,8,43,50,55,56,59,61)

Notes: Provided are the most commonly cited recommendations from guidelines for each aspect of MTX dosing, for more detailed information see Table S6. GI: gastrointestinal; MTX: methotrexate; RCT: randomized controlled trial; wk: week.

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