RESEARCH - Multinational evidence-based recommendations for the use of MTX in rheumatic disorders

[Guest guest]

Ann Rheum Dis. 2008 Nov 25.

Multinational evidence-based recommendations for the use of

methotrexate in rheumatic disorders with a focus on rheumatoid

arthritis: integrating systematic literature research and expert

opinion of a broad international panel of rheumatologists in the 3E

Initiative.

Visser K, Katchamart W, Loza E, ez- JA, Salliot C, Trudeau

J, Bombardier C, Carmona L, van der Heijde D, Bijlsma JW, Boumpas DT,

Canhao H, CJ, Hamuryudan V, Kvien TK, Leeb BF, Martín-Mola EM,

Mielants H, Müller-Ladner U, G, Ostergaard M, Pereira IA,

Ramos-Remus C, Valentini G, Zochling J, Dougados M.

Leiden University Medical Center, Netherlands.

OBJECTIVES: To develop evidence-based recommendations for the use of

methotrexate (MTX) in daily clinical practice in rheumatic disorders.

METHODS: A total of 751 rheumatologists from 17 countries participated

in the 3E (Evidence Expertise Exchange) Initiative of 2007-2008

consisting of 3 separate rounds of discussions and Delphi votes. Ten

clinical questions concerning the use of MTX in rheumatic disorders

were formulated. A systematic literature search in Medline, Embase,

Cochrane Library and 2005-2007 ACR/EULAR meeting abstracts was

conducted. Selected articles were systematically reviewed and the

evidence was appraised according to the Oxford Levels of Evidence.

Each country elaborated a set of national recommendations. Finally,

multinational recommendations were formulated and agreement among the

participants and the potential impact on their clinical practice was

assessed.

RESULTS: A total of 16979 references were identified, of which 304

articles were included in the systematic reviews. Ten multinational

key recommendations on the use of MTX were formulated. Nine

recommendations were specific for rheumatoid arthritis, including the

work-up before initiating MTX, optimal dosage and route, use of folic

acid, monitoring, management of hepatotoxicity, long-term safety, mono

versus combination therapy and management in the peri-operative period

and before/during pregnancy. One recommendation concerned MTX as a

steroid-sparing agent in other rheumatic diseases.

CONCLUSIONS: Ten recommendations for the use of MTX in daily clinical

practice focussed on RA were developed, which are evidence-based and

supported by a large panel of rheumatologists, enhancing their

validity and practical use.

PMID: 19033291

http://www.ncbi.nlm.nih.gov/pubmed/19033291

********************************************

Read the full article here:

http://ard.bmj.com/cgi/rapidpdf/ard.2008.094474v1

Not an MD