Evidence map›Paper›PMID 19033290›Full record

SynthesisAnnals of the rheumatic diseases2009

Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature.

K Visser, D van der Heijde

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of the rheumatic diseases, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05353829 (Efficacy, Tolerability and Preferences of Per Oral or Subcutaneous Methotrexate in Patients with Early Rheumatoid Arthritis - a Randomised Register Based Multicentre Study), which is not on this map. Cited by 110 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
110citing papers in PubMed, 10 pooled it
8.4field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05353829 phase4active not recruitingnot on this mapstarted 2022, after this paper: background citation

Efficacy, Tolerability and Preferences of Per Oral or Subcutaneous Methotrexate in Patients with Early Rheumatoid Arthritis - a Randomised Register Based Multicentre Study

TypeinterventionalSponsorRegion VästerbottenRan2022 to 2026Enrolled212ConditionsRheumatoid ArthritisArmsMethotrexate
3 · Its place in the literature

Who cites it

110 citing papers in PubMed, 10 syntheses or guidelines pooled it, 321 citations in OpenAlex.

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50 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

K VisserDepartment of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. K.Visser@lumc.nl
D van der Heijde
Leiden University Medical Center · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo review systematically the available literature on the optimal dosage and route of administration of methotrexate in patients with rheumatoid arthritis (RA), as an evidence base for generating clinical practice recommendations.

methodsA systematic literature search was carried out in MEDLINE, EMBASE, Cochrane Library and American College of Rheumatology/European League Against Rheumatism meeting abstracts, searching for randomised controlled trials evaluating various dosages or routes of administration of methotrexate in RA. Articles that fulfilled predefined inclusion criteria were systematically reviewed and the quality was appraised. Effect sizes and odds ratios for clinical, radiological and toxicity outcomes were calculated and directly or indirectly compared between study groups using methotrexate in different dosages or by different routes.

resultsA total of 38 publications out of 1748 identified references was included in the review. Start doses of 25 mg/week or fast escalation with 5 mg/month to 25-30 mg/week were associated with higher clinical effect sizes and more (gastrointestinal) adverse events in comparison with doses of 5-15 mg/week or slow escalation. Starting with 15 mg/week subcutaneous versus oral methotrexate was associated with higher clinical efficacy but more withdrawal due to toxicity in early RA. In longstanding RA, after failure on 15-20 mg/week orally, a switch to 15 mg/week intramuscularly with subsequent dose escalation did not result in increased efficacy.

conclusionsStarting on methotrexate 15 mg/week orally, escalating with 5 mg/month to 25-30 mg/week, or the highest tolerable dose, with a subsequent switch to subcutaneous administration in the case of an insufficient response, seems to be the optimal evidence-based dosing and routing recommendation for methotrexate in RA.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidDrug Administration RoutesDrug Administration ScheduleHumansMethotrexateRandomized Controlled Trials as TopicAntirheumatic AgentsMethotrexate

Identifiers

PMID19033290
PMCPMC2689521
OpenAlexW2121311666

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.