Methotrexate guidelines 2009?
2010; Elsevier BV; Volume: 63; Issue: 2 Linguagem: Inglês
10.1016/j.jaad.2009.08.068
ISSN1097-6787
AutoresHenry H. Roenigk, Robert Auerbach, Howard I. Maïbach,
Tópico(s)Health Systems, Economic Evaluations, Quality of Life
ResumoTo the Editor: The article by Kalb et al1Kalb R.E. Strober B. Weinstein G. Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.J Am Acad Dermatol. 2009; 60: 824-837Abstract Full Text Full Text PDF PubMed Scopus (261) Google Scholar in the May 2009 issue of the Journal was prepared as an update of previous methotrexate guidelines.2Roenigk Jr., H.H. Maibach H.I. Weinstein G.D. Use of methotrexate in psoriasis.Arch Dermatol. 1972; 105: 363-365Crossref PubMed Scopus (72) Google Scholar, 3Roenigk Jr., H.H. Auerbach R. Maibach H.I. Weinstein G.D. Methotrexate guideline—revised.J Am Acad Dermatol. 1973; 108: 36-42Google Scholar, 4Roenigk Jr., H.H. Auerbach R. Maibach H.I. Weinstein G.D. Methotrexate guidelines—revised.J Am Acad Dermatol. 1982; 6: 145-155Abstract Full Text PDF PubMed Scopus (200) Google Scholar, 5Roenigk Jr., H.H. Auerbach R. Maibach H.I. Weinstein G.D. Methotrexate in psoriasis: consensus conference.J Am Acad Dermatol. 1998; 38: 478-485Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar Three of the original four authors (H.R., H.M., and R.A.) of previous methotrexate guidelines were not consulted in the 2009 update. Why have the guidelines changed from a function of the American Academy of Dermatology (AAD) to the National Psoriasis Foundation (NSF)? A recent member alert (June 22, 2009) from the AAD, requested “member review and comment on the fourth section of newly developed evidenced based Guidelines of Care for the Management and Treatment of Psoriasis.” The Psoriasis Expert Work Group of AAD includes some of the authors of the NSF Methotrexate and Psoriasis 2009 publication.1Kalb R.E. Strober B. Weinstein G. Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.J Am Acad Dermatol. 2009; 60: 824-837Abstract Full Text Full Text PDF PubMed Scopus (261) Google Scholar The NSF is a patient advocacy organization, which may have funding conflicts from companies that make products to treat psoriasis. The AAD Guideline committee avoided these conflicts and tried to present sound scientific evidence. The AAD has a Guidelines Research Committee that reviews revised guidelines, and finally the AAD Board of Directors gives final approval. This structure, which was used for initial methotrexate guidelines, avoids conflicts of interest. Kalb et al1Kalb R.E. Strober B. Weinstein G. Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.J Am Acad Dermatol. 2009; 60: 824-837Abstract Full Text Full Text PDF PubMed Scopus (261) Google Scholar quote Table III from the methotrexate guidelines written by the American College of Rheumatology (ACR) and not the Arthritis Foundation. The Kalb et al1Kalb R.E. Strober B. Weinstein G. Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.J Am Acad Dermatol. 2009; 60: 824-837Abstract Full Text Full Text PDF PubMed Scopus (261) Google Scholar article largely is taken unchanged from the 1998 methotrexate guidelines.5Roenigk Jr., H.H. Auerbach R. Maibach H.I. Weinstein G.D. Methotrexate in psoriasis: consensus conference.J Am Acad Dermatol. 1998; 38: 478-485Abstract Full Text Full Text PDF PubMed Scopus (318) Google Scholar The only changes are to liberalizing the monitoring for hepatotoxicity by using ACR criteria and recommending increasing the total dose of methotrexate in the no risk group to first biopsy to 3.5 to 4.0 g instead of 1.0 to 1.5 g. Most references were from the rheumatology and gastrointestinal literature, and some references are merely opinion. We agree with a more liberal approach, but wish that Kalb et al1Kalb R.E. Strober B. Weinstein G. Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.J Am Acad Dermatol. 2009; 60: 824-837Abstract Full Text Full Text PDF PubMed Scopus (261) Google Scholar would publish their own data in psoriasis patients to support their conclusions rather than depending on opinions based on rheumatologic patients. It is important to compare and contrast other specialty's management guidelines and to cite their references, but the balance of data to change guidelines should be from our own patient population when possible. We feel that the guidelines have been helpful to dermatologists. Changing recommendations should be made on solid data on psoriasis patients and not on opinions of other specialties based on different patient populations. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus ConferenceJournal of the American Academy of DermatologyVol. 60Issue 5PreviewMethotrexate remains a valuable option for the treatment of psoriasis. This report will summarize studies regarding the use of methotrexate since the last guidelines were published in 1998. Full-Text PDF Response to the letter to editor re: “Methotrexate and psoriasis: Consensus conference”Journal of the American Academy of DermatologyVol. 66Issue 4PreviewTo the Editor: I read with interest the recent letter to the editor by Kalb et al,1 responding to an earlier letter by Roenigk et al2 on “Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference.”3 Full-Text PDF Methotrexate and psoriasis: Consensus conferenceJournal of the American Academy of DermatologyVol. 64Issue 6PreviewTo the Editor: We appreciate the comments of Dr Roenigk, Dr Auerbach, and Dr Maibach1 regarding our article, “Methotrexate and Psoriasis: 2009 National Psoriasis Foundation Consensus Conference.”2 We would like to acknowledge the work of these physicians who pioneered the use of methotrexate and developed the initial guidelines for its use. Their work was acknowledged with praise in our methotrexate article. We would like to apologize for not having consulted them directly. Full-Text PDF
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