Recommendations for the Use of Parenteral Methotrexate in Rheumatic Diseases

Molina, Jesús Tornero; Alén, Jaime Calvo; Ballina, Javier; Belmonte, María Ángeles; Blanco, Francisco J.; Caracuel, Miguel A.; Carbonell, Jordi; Corominas, H.; Chamizo, E.; Hidalgo, Cristina; Ivorra, José Román; Marenco, José Luis; Muelas, José Vicente Moreno; Nolla, Joan M.; Pérez, Trinidad; Sanmartí, Raimón; Trénor, Pilar; Urrego, Claudia; Vidal, Julie

doi:10.1016/j.reumae.2016.12.003

Cited by 6 publications

(4 citation statements)

References 44 publications

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“…On the other hand, MTX po might be recommended because it is the drug for which most evidence is available due to its lower price (cost-effectiveness). However, it is important to remember that the bioavailability of parenteral MTX is higher than that of MTX po, particularly at doses of ≥15 mg/week [ 54 , 55 ], and that in patients with an inadequate response to orally administered MTX (15 mg/week), dose scaling using parenteral MTX is more clinically effective [ 55 , 56 ]. Likewise, we should always consider patient opinion and preference when making therapeutic decisions.…”

Section: Resultsmentioning

confidence: 99%

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Initial Treatment with Biological Therapy in Rheumatoid Arthritis

Tornero Molina,

Hernández-Cruz,

Corominas

2023

JCM

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Background: We aimed to analyse the effectiveness, efficiency, and safety of initial treatment with biological therapies in rheumatoid arthritis (RA). Methods: Qualitative study. A group of RA experts was selected. A scoping review in Medline was conducted to analyse the evidence of initial RA treatment with biological therapies. Randomised clinical trials were selected. Two reviewers analysed the articles and compiled the data, whose quality was assessed using the Jadad scale. The experts discussed the review’s findings and generated a series of general principles: Results: Seventeen studies were included. Most of the included patients were middle-aged women with early RA (1–7 months) and multiple poor prognostic factors. Initial treatment with TNF-alpha inhibitors combined with methotrexate (MTX) and an IL6R inhibitor (either in mono or combination therapy) is effective (activity, function, radiographic damage, quality of life), safe, and superior to MTX monotherapy in the short and medium term. In the long term, patients who received initial treatment with biologicals presented better results than those whose initial therapy was with MTX. Conclusions: Initial treatment of RA with biological therapies is effective, efficient, and safe in the short, medium, and long term, particularly for patients with poor prognostic factors.

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Section: Resultsmentioning

confidence: 99%

“…Another point to note is that recommendations include the use of MTX po (vs. MTX sc) in combination with bDMARD, both because more evidence is available and due to cost. However, the option of MTX sc should be evaluated case by case since its bioavailability is greater and the patient may prefer this route of administration [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Initial Treatment with Biological Therapy in Rheumatoid Arthritis

Tornero Molina,

Hernández-Cruz,

Corominas

2023

JCM

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“…Besides functional limitations, participants could have preconceived negative feelings toward injectable MTX (affective attitude), which could increase avoidance behaviors towards MTX injection (56). It is important for health care professionals to counter any myth or misconception that MTX injection is only used for treatment of cancer (60) while discussing with their patients that there is good rationale for using parenteral MTX, such as easing the burden on patients who have swallowing difficulties (61).…”

Section: Discussionmentioning

confidence: 99%

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

Tan

Reeve

Fraser

et al. 2023

Arthritis Care & Research

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ObjectiveMethotrexate (MTX) is effective in controlling disease activity in rheumatoid arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients’ perspectives on the barriers and enablers in the use of parenteral MTX and to identify the research gaps in this field.MethodsThe search was performed in Medline, Embase, Scopus, and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study that explored the use of parenteral MTX by adult RA patients from the patients’ perspective, written in English.ResultsFifteen studies were included; findings related to the constructs “affective attitude,” “burden,” “intervention coherence,” and “self‐efficacy” were explored the most, while some were rarely (“opportunity cost” and “perceived effectiveness”) or not (“ethicality”) reported. RA patients were generally satisfied with MTX injections (“affective attitude”). From the burden construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler.ConclusionThe findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self‐administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research.image

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“…В рекомендациях Европейского альянса ревматологических ассоциаций (EULAR, European Alliance of Associations for Rheumatology) [7,[16][17][18][19][20], Американской коллегии ревматологов (ACR, American College of Rheumatology) [16-18, 21, 22], Азиатско-Тихоокеанской лиги ассоциаций ревматологов (APLAR, Asia Pacifi c League of Associations for Rheumatology) [23], национальных ассоциаций ревматологов [17,18,[24][25][26][27][28][29][30][31][32][33][34][35] и Ассоциации ревматологов России (АРР) [16,36,37] МТ рассматривается как препарат «выбора» для индукции и поддержания ремиссии у пациентов с ранним и развернутым РА, в том числе нуждающихся в проведении комбинированной терапии МТ с глюкокортикоидами (ГК), стандартными (с) БПВП, ГИБП и тБПВП. После постановки диагноза РА лечение МТ следует начинать как можно раньше [19].…”

Section: рекомендацииunclassified

The use of methotrexate in rheumatoid arthritis. Recommendations of the All-Russian public organization “Association of Rheumatologists of Russia”

Nasonov,

Amirjanova,

Olyunin

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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Rheumatoid arthritis (RA) is the most frequent immunoinflammatory (autoimmune) rheumatic disease characterized by chronic erosive arthritis and systemic damage to internal organs. The data obtained in the course of basic research on deciphering the mechanisms of action of methotrexate (MT) and the materials of numerous randomized placebocontrolled trials, observational studies and national registries have strengthened the position of MT as the “gold standard” of RA pharmacotherapy and a key component of the “Treatment to Target” strategy. This was the basis for the development of new recommendations of the Association of Rheumatologists of Russia (ARR) concerning the use of MT in RA, according to which MT is considered as the drug of “choice” for induction and maintenance of remission in patients with early and advanced RA, including those who need combination therapy of MT with glucocorticoids, standard Disease-Modifying Antirheumatic Drugs (DMARDs), biologics and targeted synthetic DMARDs. Special attention is paid to the safety of MT therapy and the impact of MT on comorbid pathology associated with cardiovascular complications and interstitial lung disease. Implementation of the ARR recommendations into clinical practice will reduce the risk of disability and improve life prognosis in patients with RA.

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Recommendations for the Use of Parenteral Methotrexate in Rheumatic Diseases

Cited by 6 publications

References 44 publications

Initial Treatment with Biological Therapy in Rheumatoid Arthritis

Initial Treatment with Biological Therapy in Rheumatoid Arthritis

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

The use of methotrexate in rheumatoid arthritis. Recommendations of the All-Russian public organization “Association of Rheumatologists of Russia”

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