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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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Visser, K and Katchamart, W and Loza, E and Martinez-Lopez, JA and Salliot, C and Trudeau, J and Bombardier, C and Carmona, L and van der Heijde, D and Bijlsma, JWJ and Boumpas, DT and Canhao, H and Edwards, CJ and Hamuryudan, V and Kvien, TK and Leeb, BF and Martin-Mola, EM and Mielants, H and Muller-Ladner, U and Murphy, G and Ostergaard, M and Pereira, IA and Ramos-Remus, C and Valentini, G and Zochling, J and Dougados, M (2008) 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. Annals of the Rheumatic Diseases, 68. pp. 1086-1093. ISSN 0003-4967

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Abstract

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.

Item Type: Article
Keywords: methotrexate, rheumatoid arthritis, rheumatic disorders, recommendations, systematic review
Journal or Publication Title: Annals of the Rheumatic Diseases
Page Range: pp. 1086-1093
ISSN: 0003-4967
Identification Number - DOI: 10.1136/ard.2008.094474
Additional Information: Copyright © 2008 BMJ Publishing Group Ltd & European League Against Rheumatism Definitive version available at: http://ard.bmj.com/cgi/content/abstract/ard.2008.094474v1549
Date Deposited: 24 Feb 2009 02:41
Last Modified: 18 Nov 2014 03:56
URI: http://eprints.utas.edu.au/id/eprint/8389
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