Italian consensus on the recommendations about the use of methotrexate for the treatment of rheumatic diseases with a focus on rheumatoid arthritis: results from the “3E initiative”

Abstract

Nonostante il frequente utilizzo, la nota efficacia e la grande esperienza accumulata in più di venti anni dalla sua introduzione nella pratica clinica linee-guida inerenti al suo impiego in Reumatologia non sono state sinora pubblicate. L'approccio dei reumatologi in riferimento a diversi aspetti del suo utilizzo rimane quindi a tutt'oggi molto eterogeneo, empirico e basato sull'esperienza personale. L'iniziativa "3E (Evidence, Expertise, Exchange) in Rheumatology" per l'anno 2007-2008 è stata dedicata alla formulazione di un set di raccomandazioni sull'uso del MTX nelle malattie reumatiche, e in particolare nell'AR. L'iniziativa "3E in Rheumatology" è nata col fine di definire e divulgare, sia a livello internazio-INTRODUZIONE I l methotrexate (MTX) è il DMARD (diseasemodifying antirheumatic drug) più utilizzato per il trattamento dell'artrite reumatoide (AR) ed è prescritto anche a pazienti affetti da altre malattie reumatiche (1, 2). Reumatismo, 2010; 62(1)

Methotrexate and Rheumatoid Arthritis: Current Evidence Regarding Subcutaneous Versus Oral Routes of Administration

“…Bioavailability data discussed herein are reflected in the latest Italian recommendations and guidelines on the management of RA [ 7 , 22 ]. While guidelines permit a broad therapeutic range (7.5–25.0 mg/week), the optimal treatment strategy requires initial doses higher than those recommended in the past (12.5–15.0 mg/week).…”

“…references resulting from the search No. references included in the study References PubMed and Medline query Methotrexate and subcutaneous (or parenteral) and oral and rheumatoid arthritis 108 8 [ 11 – 17 , 21 , 23 ] Methotrexate and subcutaneous (or parenteral) and oral and pharmacokinetic 19 2 [ 12 , 13 ] Methotrexate and subcutaneous (or parenteral) and oral and efficacy 35 4 [ 12 , 14 , 17 , 21 ] Methotrexate and subcutaneous (or parenteral) and oral and toxicity 55 1 [ 21 ] Other Studies already known by authors and/or cited in other articles – 2 [ 18 , 19 ] Reviews, guidelines, other articles already known by authors and/or cited in other articles – 12 [ 1 – 10 , 20 , 22 ] …”

Efficacy and Metabolic Effect on Serum Lipids of Apremilast in Psoriatic Arthritis: A Case Report

“…However, he did not reach complete remission. Shortly after initiation, due to a 2-fold increase of liver enzymes (hepatitis excluded based on abdomen ultrasound and hepatitis B and C viral profile), methotrexate was reduced to 7.5 mg weekly [12]. The reduced methotrexate regimen led to normalization of the liver enzymes but was ineffective in controlling both skin and joint involvement.…”

Systematic review of 2008-2012 literature and update of recommendations for the use of methotrexate in rheumatic diseases, with a focus on rheumatoid arthritis

“…On this occasion, the 10 international recommendations along with five recommendations added by the Italian team, were discussed and reformulated, including an appraisal of the strength of the recommendation in the final version. The aim of the initiative was to standardize the Italian therapeutic approach to the use of MTX in rheumatoid arthritis (RA) and other rheumatic diseases to avoid heterogeneous conduct based on personal experience (1). The ICARUS Project was established with the aim of updating the previous recommendations, focusing on important aspects such as safety, starting dose, step-up strategy and route of administration.…”