RESEARCH - Influence of guideline adherence on outcome on the efficacy of MTX with folate supplementation in RA

September 21, 2004

Ann Rheum Dis. 2004 Oct;63(10):1222-6.

Influence of guideline adherence on outcome in a randomised controlled

trial on the efficacy of methotrexate with folate supplementation in

rheumatoid arthritis.

Fransen J, Laan RF, Van Der Laar MA, Huizinga TW, Van Riel PL.

Department of Rheumatology, University Medical Centre Nijmegen, PO Box

9101, 6500 HB Nijmegen, Netherlands. j.fransen@...

OBJECTIVE: To study the influence of rheumatologists' adherence to a

methotrexate guideline on efficacy and toxicity in the treatment of

rheumatoid arthritis. METHODS: In a 48 week randomised controlled trial

of methotrexate, comparing folates with placebo, rheumatologists were

advised on methotrexate dosage using a guideline reflecting daily

practice. The influence of guideline non-adherence on outcome was

analysed using generalised estimating equations and survival analysis.

RESULTS: In 51% of the 411 study patients the guidelines were always

followed. Non-adherence resulted in lower doses of methotrexate in 25%

of cases, and higher doses in 24%. The reduction in the disease activity

score was significantly greater (mean -0.4; p = 0.0085) in the adherent

group than in the " low dose " group; the " high dose " group did not differ

from the adherent group. Dropout caused by severe adverse events did not

differ between the three groups.

CONCLUSIONS: There is an indication that adherence to guidelines on

methotrexate dosage may benefit patients with rheumatoid arthritis by

improving disease activity without increasing toxicity. For definite

proof, a randomised controlled trial comparing guideline supported

dosing with usual care is needed.

PMID: 15361375

5361375 & dopt=Abstract

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Mayo Clinic in Rochester

s Hopkins Medicine

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