Use of Methotrexate in the Treatment of Moderate to Severe Plaque Psoriasis in France: A Practice Survey

Anne-Claire Fougerousse; Laure Mery-Bossard; Josiane Parier; Charles Taieb; Antoine Bertolotti; Francois Maccari; GEM ResoPso

doi:10.2147/CCID.S311269

Use of Methotrexate in the Treatment of Moderate to Severe Plaque Psoriasis in France: A Practice Survey

Clin Cosmet Investig Dermatol. 2021 Apr 23:14:389-393. doi: 10.2147/CCID.S311269. eCollection 2021.

Authors

Anne-Claire Fougerousse¹, Laure Mery-Bossard², Josiane Parier³, Charles Taieb⁴, Antoine Bertolotti^{5

6}, Francois Maccari³; GEM ResoPso

Affiliations

¹ Dermatology Department, Hôpital d'Instruction des Armées Bégin, Saint Mandé, 94160, France.
² Dermatology Department, Centre Hospitalier Intercommunal Poissy Sant Germain en Laye, Saint-Germain-en-Laye, 78100, France.
³ Private Practice, La Varenne Saint Hilaire, Saint-Maur-des-Fossés, 94210, France.
⁴ European Market Maintenance Assessment, Patients Priority Department, Fontenay sous-Bois, France.
⁵ Infectious Diseases and Dermatology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, France.
⁶ Inserm CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, La Réunion, France.

Abstract

Purpose: To evaluate the modalities of methotrexate prescription for moderate to severe psoriasis by dermatologists in France.

Patients and methods: We performed a national online practice survey between October and December 2020.

Results: A total of 254 dermatologists responded, 237 reported prescribing methotrexate for moderate to severe psoriasis in adults, of which 57% as a first line systemic treatment. Nineteen percent reported performing a test dose at the initiation of treatment. Methotrexate was prescribed orally in 54.7% of cases, subcutaneously in 44.8% of cases and intramuscularly in 0.4% of cases. The initial weekly dose of methotrexate was <15 mg for 30% of the dermatologists and ≥15 mg for 70% of them. Two hundred and three dermatologists had already change the route of administration for methotrexate from the oral to injectable form due to poor tolerance (48.3%), lack of efficacy (35%) or lack of compliance (16.7%). Two hundred thirty-four dermatologists (98.7%) reported prescribing folic acid with methotrexate, and 79.3% reported prescribing tests evaluating the risk of hepatic fibrosis. Forty-three percent of dermatologists have not initiated or have reduced their prescriptions since the beginning of the pandemic of COVID-19. Prescribing patterns were different according to the type of practice (private practice versus hospital/mixed practice).

Conclusion: Methotrexate is used by the majority of dermatologists interviewed for moderate to severe psoriasis in adults, with heterogeneity of practices.

Keywords: dermatologists; methotrexate; practice survey; psoriasis.