INTRODUCTION
Methotrexate (MTX) is an immunosuppressive medication used to treat a wide range of dermatological conditions, most commonly psoriasis.1 MTX was first approved by the Food and Drug Administration (FDA) in 1972 for the treatment of severe, recalcitrant psoriasis.2 This was before the acceptance of randomized control trials as the standard to judge drug efficacy. Therefore, there have been no large-scale, high quality studies looking at the efficacy and safety of MTX to date.2 For this reason, dermatology guidelines regarding MTX treatment were written, and continue to be revised, based solely on expert opinion.
MTX use requires intermittent monitoring of blood counts, renal function, and liver function. However, current laboratory monitoring guidelines for dermatological patients on MTX are variable, particularly within the first 90 days of therapy, and practices are highly provider and institution dependent.3 For example, the most recent edition of Comprehensive Dermatologic Drug Therapy, which is often referenced by dermatology residents and attending physicians, cites guidelines written in 1988 by Roenigk et al, who recommend obtaining a complete blood count (CBC), platelet count, and liver function tests (LFTs) every 1–2 weeks for the first 2–4 weeks, 1–2 weeks after dose escalations, and a gradual decrease to every 3–4 months long term.4 The British Association of Dermatologists, similarly, recommends obtaining a CBC, LFTs, urea and electrolytes every 7–14 days for the first month, decreasing to every 2–3 months once therapy has stablized.5 Guidelines from the 2009 National Psoriasis Foundation Conference, on the other hand, endorse obtaining a CBC with platelet count every 2–4 weeks for the first several months, then every 1–3 months depending on the stability of the patient.6
Rheumatology guidelines governing MTX blood monitoring are generally less stringent.7 A study performed by Busger op Vollenbroek et al in 2018 determined that strict monitoring by dermatologists led to more abnormal findings and reduced drug survival, with no difference in the number of serious adverse events when compared to rheumatology patients.1
The purpose of this study was to gain a clearer understanding of methotrexate monitoring practices currently being utilized by dermatologists at one institution. Specifically, we sought
MTX use requires intermittent monitoring of blood counts, renal function, and liver function. However, current laboratory monitoring guidelines for dermatological patients on MTX are variable, particularly within the first 90 days of therapy, and practices are highly provider and institution dependent.3 For example, the most recent edition of Comprehensive Dermatologic Drug Therapy, which is often referenced by dermatology residents and attending physicians, cites guidelines written in 1988 by Roenigk et al, who recommend obtaining a complete blood count (CBC), platelet count, and liver function tests (LFTs) every 1–2 weeks for the first 2–4 weeks, 1–2 weeks after dose escalations, and a gradual decrease to every 3–4 months long term.4 The British Association of Dermatologists, similarly, recommends obtaining a CBC, LFTs, urea and electrolytes every 7–14 days for the first month, decreasing to every 2–3 months once therapy has stablized.5 Guidelines from the 2009 National Psoriasis Foundation Conference, on the other hand, endorse obtaining a CBC with platelet count every 2–4 weeks for the first several months, then every 1–3 months depending on the stability of the patient.6
Rheumatology guidelines governing MTX blood monitoring are generally less stringent.7 A study performed by Busger op Vollenbroek et al in 2018 determined that strict monitoring by dermatologists led to more abnormal findings and reduced drug survival, with no difference in the number of serious adverse events when compared to rheumatology patients.1
The purpose of this study was to gain a clearer understanding of methotrexate monitoring practices currently being utilized by dermatologists at one institution. Specifically, we sought
