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

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.

Automated summary

The survey revealed that there are significant variations in prescription patterns and practices when dermatologists in France treat moderate to severe psoriasis with methotrexate, with the majority of practitioners prescribing folic acid alongside the medication. Some physicians have already switched from oral to injectable methotrexate due to issues with tolerance, lack of efficacy, or compliance. The COVID-19 pandemic has also impacted prescription behaviors, with some dermatologists either not initiating or reducing their prescriptions as a result.