Oral Methotrexate in split dose weekly versus oral or parenteral Methotrexate once weekly in Rheumatoid Arthritis: a short‐term study

Dhaon, Pooja; Das, Siddharth Kumar; Srivastava, Ragini; Agarwal, Gaurav; Asthana, Abhas

doi:10.1111/1756-185x.12910

Cited by 27 publications

(25 citation statements)

References 22 publications

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“…Among these four included trials, there were a total of 695 patients randomized, with 370 in the oral group, and 325 in the parenteral group. One of the trials had three arms, two of which were oral treatments at the same cumulative doses, but in one arm the MTX was given in split doses [21]. To be more accurate in our assessment, we included only the group of patients that took MTX as a single dose weekly, similar to the patients in all other three studies.…”

Section: Resultsmentioning

confidence: 99%

“…To be more accurate in our assessment, we included only the group of patients that took MTX as a single dose weekly, similar to the patients in all other three studies. Although no significant differences in disease duration were recorded between the oral and parenteral groups in each individual study, the trial by Braun included mostly patients with early RA, with a median disease duration of 2.1 and 2.5 months respectively, as opposed to the studies by Dhaon [21] and Islam [22], were patients had a disease duration of 4–6 years on average. One of the studies was an abstract (Ahmed) and did not provide data on disease duration or patient’s age [23].…”

Section: Resultsmentioning

confidence: 99%

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Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis

et al. 2019

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Objective Studies suggest that parenteral MTX may be more efficacious than the oral form at equivalent doses for the treatment of rheumatoid arthritis. We carried out a meta-analysis to compare the efficacy of oral versus parenteral MTX in RA. Methods PubMed, Web of Science and Embase were systematically searched from inception to June 8 th 2017 and reviewed following PRISMA 2009 guidelines, by two independent reviewers. To be included, trials had to study adults with RA randomized to the same dose of either oral or parenteral MTX. The primary endpoint was ACR20 at 6 months. Intention-to-treat analysis results were used when possible. Data from direct comparisons between oral and parenteral methotrexate quantitatively analyzed using maximum likelihood random effects meta-analysis. Relative treatment effects were generated as an odds ratio [OR] (OR>1 indicated a benefit for parenteral therapy). Results The search yielded 357 papers or abstracts. After review of titles or abstracts and full text papers, we found 4 that met inclusion criteria with 703 patients randomized. Dose of MTX started at 15mg/week and increased up to 25mg/week. The summary OR for achieving ACR20 using parenteral vs. oral MTX was 3.02 (95% CI 1.41, 6.46), with no significant difference in the risk for all adverse events. Conclusion Parenteral MTX therapy had significantly higher odds than oral MTX of achieving reduction in disease activity. We propose that parenteral MTX is more effective than weekly oral MTX; its widespread use may lead to better control of disease and a decrease in demand for biologic agents.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis

et al. 2019

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“…6 Dhaon et al compared the efficacy and safety of 2 regimens of oral MTX of at least 15 mg/wk (a weekly single dose and a weekly dose divided into 2-3 parts); these were also compared with MTX muscular injection. 7 The divided-dose regimen showed higher efficacy than the single-dose regimen, and its effect was comparable with that of the MTX muscular injection. However, in these reports, the dose was divided to ensure an interval of at least 2 days between administration in order to maintain intracellular MTX-polyglutamates (PGs) concentration, and the method was different from the dosage and administration specified in the package insert (12-hour interval).…”

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confidence: 84%

Weekly split‐dose regimen for oral methotrexate reduced polyglutamation in red blood cells in patients with rheumatoid arthritis compared with single‐dose regimen: Results from a multicentered randomized control trial

Nagaoka

Katayama²,

Kasama

et al. 2020

Int J of Rheum Dis

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Methotrexate (MTX) is a globally recognized disease-modifying anti-rheumatic drug considered as the anchor drug for the treatment of rheumatoid arthritis (RA); however, the major dose regimens vary among countries and region. 1-3 For example, the weekly dose is taken as a single dose in the US, but is generally divided into 2-4 parts taken at 12-hour intervals in Japan when it exceeds 8 mg. The Japanese guidelines for the use of MTX recommend the division of weekly doses above 8 mg to reduce gastrointestinal risks such as nausea. 4 However,

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“…Splitting doses of MTX, rather than intravenous administration, is a new attempt to avoid MTX associated side effects. MTX is split and given twice or thrice in a week to achieve higher bioavailability and better clinical response [ 81 , 82 ], thus providing us with a novel method of oral administration of MTX with less adverse effects.…”

Section: The Side Effects Of Mtxmentioning

confidence: 99%

A Review of Clinical Applications and Side Effects of Methotrexate in Ophthalmology

Wang

Peng

2020

Journal of Ophthalmology

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Methotrexate (MTX) is a folate analog widely used against a range of diseases including malignancies and autoimmune disorders. Its high effectiveness-price ratio also won extensive application in ophthalmology. On the other hand, although MTX has an excellent pharmacological efficacy, MTX associated side effects in clinical use, which vary from patient to patient, are nonnegligible. There is no comparatively systematic review on MTX associated side effects and its risk factors. This review aimed to reveal novel clinical approaches of MTX and its adverse effects in order to provide a reference for ophthalmic scholars in clinical application of MTX.

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Oral Methotrexate in split dose weekly versus oral or parenteral Methotrexate once weekly in Rheumatoid Arthritis: a short‐term study

Abstract: Oral split doses of MTX are better than an oral single dose and similar to parenteral MTX in terms of efficacy.

Cited by 27 publications

References 22 publications

Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis

Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis

Weekly split‐dose regimen for oral methotrexate reduced polyglutamation in red blood cells in patients with rheumatoid arthritis compared with single‐dose regimen: Results from a multicentered randomized control trial

A Review of Clinical Applications and Side Effects of Methotrexate in Ophthalmology

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