TY - JOUR T1 - Experts document on methotrexate use in combined therapy with biological or targeted synthetic disease modifying drugs in patients with rheumatoid arthritis JO - Reumatología Clínica T2 - AU - Tornero-Molina,Jesús AU - Alperi-López,Mercedes AU - Castellví,Ivan AU - de Agustín-de Oro,Juan José AU - Escudero,Alejandro AU - García-Vicuña,Rosario AU - González-Gay,Miguel Ángel AU - Hidalgo,Cristina AU - Rubio,Esteban AU - Sanmartí,Raimon AU - Casamira,Núria AU - Calvo-Alén,Jaime SN - 1699258X M3 - 10.1016/j.reuma.2020.08.003 DO - 10.1016/j.reuma.2020.08.003 UR - https://reumatologiaclinica.org/es-experts-document-on-methotrexate-use-articulo-S1699258X2030200X AB - ObjectiveWe aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). MethodsEleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted ‘yes’ (yes/no). ResultsThe systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients’ risk management. ConclusionsThis document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs. ER -