Recommendations for the use of parenteral methotrexate in rheumatic diseases
Reumatol Clin (Engl Ed). 2018 May-Jun;14(3):142-149.
doi: 10.1016/j.reuma.2016.12.001.
Epub 2017 Jan 9.
[Article in
English,
Spanish]
Authors
Jesús Tornero Molina
1
, Jaime Calvo Alen
2
, Javier Ballina
3
, María Ángeles Belmonte
4
, Francisco J Blanco
5
, Miguel Ángel Caracuel
6
, Jordi Carbonell
7
, Héctor Corominas
8
, Eugenio Chamizo
9
, Cristina Hidalgo
10
, José Román Ivorra
11
, José Luis Marenco
12
, José Vicente Moreno Muelas
13
, Santiago Muñoz-Fernández
14
, Joan M Nolla
15
, Trinidad Pérez
16
, Raimon Sanmarti
17
, Pilar Trenor
18
, Claudia Urrego
19
, Javier Vidal
20
, José Rosas Gomez de Salazar
21
Affiliations
- 1 Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España. Electronic address: jtornero@sescam.org.
- 2 Hospital Universitario Araba, Vitoria, España.
- 3 Hospital Universitario Central de Asturias, Oviedo, España.
- 4 Hospital Regional Universitario de Málaga, Málaga, España.
- 5 Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, España.
- 6 Hospital Universitario Reina Sofía, Córdoba, España.
- 7 Hospital del Mar, Barcelona, España.
- 8 Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España.
- 9 Hospital de Mérida, Badajoz, España.
- 10 Complejo Asistencial Universitario de Salamanca, Salamanca, España.
- 11 Hospital Universitari i Politècnic La Fe, Valencia, España.
- 12 Hospital Virgen de Valme, Sevilla, España.
- 13 Hospital Universitari Vall d'Hebron, Barcelona, España.
- 14 Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, España.
- 15 Hospital Universitari de Bellvitge, Barcelona, España.
- 16 Hospital de León, León, España.
- 17 Hospital Universitari Clínic, Barcelona, España.
- 18 Hospital Clínico de Valencia, Valencia, España.
- 19 Complejo Asistencial de Segovia, Segovia, España.
- 20 Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España.
- 21 Hospital Marina Alta de la Villajoyosa, Alicante, España.
Abstract
Objective:
To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
Methods:
A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).
Results:
Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.
Conclusions:
The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
Keywords:
Enfermedades reumáticas; Methotrexate; Metrotexato; Parenteral; Rheumatic diseases.
Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Publication types
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Consensus Development Conference
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Systematic Review
MeSH terms
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Antirheumatic Agents / administration & dosage
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Antirheumatic Agents / adverse effects
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Antirheumatic Agents / pharmacokinetics
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Antirheumatic Agents / therapeutic use*
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Arthritis, Rheumatoid / drug therapy
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Biological Availability
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Clinical Decision-Making
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Dose-Response Relationship, Drug
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Drug Administration Routes
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Evidence-Based Medicine
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Humans
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Medication Adherence
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Methotrexate / pharmacokinetics
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Methotrexate / therapeutic use*
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Patient Education as Topic
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Practice Guidelines as Topic*
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Quality of Life
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Randomized Controlled Trials as Topic
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Rheumatic Diseases / drug therapy*
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Self Administration
Substances
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Antirheumatic Agents
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Methotrexate