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    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.

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    Authors
    Visser, K
    Katchamart, W
    Loza, E
    Martinez-Lopez, J A
    Salliot, C
    Trudeau, J
    Bombardier, C
    Carmona, L
    van der Heijde, D
    Bijlsma, J W J
    Boumpas, D T
    Canhao, H
    Edwards, C J
    Hamuryudan, V
    Kvien, T K
    Leeb, B F
    Martín-Mola, E M
    Mielants, H
    Müller-Ladner, U
    Murphy, G
    Østergaard, M
    Pereira, I A
    Ramos-Remus, C
    Valentini, G
    Zochling, J
    Dougados, M
    Show allShow less
    Affiliation
    Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands. k.visser@lumc.nl
    Issue Date
    2009-07
    MeSH
    Abnormalities, Drug-Induced
    Administration, Oral
    Antirheumatic Agents
    Drug Therapy, Combination
    Evidence-Based Medicine
    Female
    Folic Acid
    Humans
    Long-Term Care
    Male
    Methotrexate
    Preconception Care
    Rheumatic Diseases
    Risk Factors
    Show allShow less
    
    Metadata
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    Citation
    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. 2009, 68 (7):1086-93 Ann. Rheum. Dis.
    Publisher
    BMJ Publishing Group Ltd
    Journal
    Annals of the rheumatic diseases
    URI
    http://hdl.handle.net/10147/200982
    DOI
    10.1136/ard.2008.094474
    PubMed ID
    19033291
    Additional Links
    http://ard.bmj.com/content/68/7/1086.full.pdf+html
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689523/pdf/ard-68-07-1086.pdf
    Abstract
    To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders.
    751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007-8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005-7 American College of Rheumatology/European League Against Rheumatism 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.
    A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases.
    Ten recommendations for the use of methotrexate 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.
    Item Type
    Article
    Language
    en
    ISSN
    1468-2060
    ae974a485f413a2113503eed53cd6c53
    10.1136/ard.2008.094474
    Scopus Count
    Collections
    Cork University Hospital

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