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Vol. 14. Issue 3.
Pages 142-149 (May - June 2018)
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Vol. 14. Issue 3.
Pages 142-149 (May - June 2018)
Original Article
DOI: 10.1016/j.reumae.2016.12.003
Recommendations for the Use of Parenteral Methotrexate in Rheumatic Diseases
Recomendaciones sobre el uso de metrotexato parenteral en enfermedades reumáticas
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Jesús Tornero Molinaa,
Corresponding author
jtornero@sescam.org

Corresponding author.
, Jaime Calvo Alenb, Javier Ballinac, María Ángeles Belmonted, Francisco J. Blancoe, Miguel Ángel Caracuelf, Jordi Carbonellg, Héctor Corominash, Eugenio Chamizoi, Cristina Hidalgoj, José Román Ivorrak, José Luis Marencol, José Vicente Moreno Muelasm, Santiago Muñoz-Fernándezn, Joan M. Nollao, Trinidad Pérezp, Raimon Sanmartiq, Pilar Trenorr, Claudia Urregos, Javier Vidala, José Rosas Gomez de Salazart
a Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, Spain
b Hospital Universitario Araba, Vitoria, Spain
c Hospital Universitario Central de Asturias, Oviedo, Spain
d Hospital Regional Universitario de Málaga, Málaga, Spain
e Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
f Hospital Universitario Reina Sofía, Córdoba, Spain
g Hospital del Mar, Barcelona, Spain
h Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
i Hospital de Mérida, Badajoz, Spain
j Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
k Hospital Universitari i Politècnic La Fe, Valencia, Spain
l Hospital Virgen de Valme, Sevilla, Spain
m Hospital Universitari Vall d’Hebron, Barcelona, Spain
n Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
o Hospital Universitari de Bellvitge, Barcelona, Spain
p Hospital de León, León, Spain
q Hospital Universitari Clínic, Barcelona, Spain
r Hospital Clínico de Valencia, Valencia, Spain
s Complejo Asistencial de Segovia, Segovia, Spain
t Hospital Marina Alta de la Villajoyosa, Alicante, Spain
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Tables (3)
Table 1. Questions Generated by the Coordinator the Responses to Which Were Encountered in the Systematic Literature Review.
Table 2. Recommendations With Level of Evidence, Grade of Recommendation and Level of Agreement.
Table 3. Methotrexate Bioequivalence.
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Abstract
Objective

To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.

Methods

A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).

Results

Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.

Conclusions

The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.

Keywords:
Methotrexate
Parenteral
Rheumatic diseases
Resumen
Objetivos

Desarrollar recomendaciones sobre el uso de metrotexato (MTX) parenteral en pacientes con enfermedades reumáticas, fundamentalmente en la artritis reumatoide, basadas en la mejor evidencia y experiencia.

Métodos

Se seleccionó un grupo de 21 expertos reumatólogos en el manejo de MTX. El coordinador generó 13 preguntas sobre el uso de MTX parenteral (perfiles de indicación, eficacia, seguridad, costo-eficacia y biodisponibilidad) para ser contestadas mediante una revisión sistemática de la literatura. Con base en las preguntas se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda (en Medline, EMBASE y la Cochrane Library). Tres revisores seleccionaron los artículos resultantes de la búsqueda. Se generaron tablas de evidencia. Paralelamente se evaluaron abstracts de congresos de la European League Against Rheumatism (EULAR) y del American College of Rheumatology (ACR). Con toda esta evidencia el coordinador generó 13 recomendaciones preliminares que se evaluaron, discutieron y votaron en una reunión del grupo nominal con los expertos. Para cada recomendación se estableció el nivel de evidencia y grado de recomendación, y el grado de acuerdo mediante un Delphi. Se definió acuerdo si al menos el 80% de los participantes contestaron sí a la recomendación (sí o no).

Resultados

La mayoría de la evidencia proviene de la artritis reumatoide. De las 13 recomendaciones preliminares se aceptaron 11 recomendaciones sobre el uso de MTX parenteral en reumatología. Dos no se llegaron a votar y se decidió no incluirlas, pero se comentan en el texto final.

Conclusiones

Este documento pretende resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con el uso de MTX parenteral.

Palabras clave:
Metrotexato
Parenteral
Enfermedades reumáticas

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