SynthesisClinical and experimental rheumatology
Outcomes related to methotrexate dose and route of administration in patients with rheumatoid arthritis: a systematic literature review.
Synthesis in Clinical and experimental rheumatology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- 2024 Update of the Asia-Pacific League of Associations for Rheumatology (APLAR) Recommendations for Rheumatoid Arthritis Management.International journal of rheumatic diseases · 2026Guideline
- Gastrointestinal adverse events among methotrexate users in rheumatoid arthritis patients: a systematic review and meta-analysis.Clinical rheumatology · 2026Pooled it
- Oral methotrexate at doses 15-25 mg/week is non-inferior to parenteral regarding efficacy and safety in the treatment of rheumatoid arthritis: a systematic review and meta-analysis.Clinical rheumatology · 2022Pooled it
- Kuwait association of rheumatology 2018 treatment recommendations for patients with rheumatoid arthritis.Rheumatology international · 2019Guideline
- A comprehensive review on thermo-responsive targeted and functional therapy for management of rheumatoid arthritis.Naunyn-Schmiedeberg's archives of pharmacology · 2026Review
- Intra-articular Methotrexate-Loaded Microsponge as an Adjuvant Strategy for Rheumatoid Arthritis: Localized Treatment with a Systemic Impact.ACS biomaterials science & engineering · 2026Article
- Comprehensive Parent-Metabolite PBPK/PD Modeling Insights Into Methotrexate Personalized Dosing Strategies in Patients With Rheumatoid Arthritis.CPT: pharmacometrics & systems pharmacology · 2025Article
- Factors related to dosing frequency and route of administration in methotrexate intolerance among patients with rheumatoid arthritis: a cross-sectional study.Therapeutic advances in drug safety · 2025Article
- Advances in Systemic Lupus Erythematosus Treatment With Monoclonal Antibodies: A Mini-Review.Cureus · 2024Review
- Impact of methotrexate on humoral and cellular immune responses to SARS-CoV-2 mRNA vaccine in patients with rheumatoid arthritis.Clinical and experimental medicine · 2023Article
- Drug-microbiota interactions: an emerging priority for precision medicine.Signal transduction and targeted therapy · 2023Review
- Consensus statements for pharmacological management, monitoring of therapies, and comorbidity management of psoriatic arthritis in the United Arab Emirates.International journal of rheumatic diseases · 2022Review
- Differences in Administration of Methotrexate and Impact on Outcome in Low-Risk Gestational Trophoblastic Neoplasia.Cancers · 2022Article
- Drug Response Diversity: A Hidden Bacterium?Journal of personalized medicine · 2021Review
- Short-term tolerability and effectiveness of methotrexate monotherapy in adult patients with Crohn's disease: a retrospective study.Therapeutic advances in gastroenterology · 2021Article
- Pharmacomicrobiology of Methotrexate in Rheumatoid Arthritis: Gut Microbiome as Predictor of Therapeutic Response.Frontiers in immunology · 2021Review
- New Horizons in Hydrogels for Methotrexate Delivery.Gels (Basel, Switzerland) · 2020Review
- Molecular mechanism of action and pharmacokinetic properties of methotrexate.Molecular biology reports · 2020Review
- Pharmacomicrobiomics in inflammatory arthritis: gut microbiome as modulator of therapeutic response.Nature reviews. Rheumatology · 2020Review
- Treatment Mode Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making.Patient preference and adherence · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesMethotrexate (MTX) is considered the 'anchor drug' in the therapy of rheumatoid arthritis (RA), yet many physicians do not optimise MTX regimens in spite of high RA disease activity. The recent development of an auto-injector for the subcutaneous (subQ) administration of MTX has prompted re-evaluation of MTX utilisation. The purpose of this systematic literature review is to determine the optimal dose, drug level, and route of administration for MTX in the context of relevant pharmacokinetics and pharmacogenomics.
methodsA systematic literature review was performed in Medline searching specifically for randomised controlled trials, systematic reviews, case control and cohort studies evaluating outcomes related to MTX dose and route of administration. Articles fulfilling these inclusion criteria were reviewed. Data on MTX dose, route of administration, clinical response, drug levels and adverse events were evaluated.
resultsOur search identified 420 articles of which 6 were eligible for inclusion using the above criteria. These included 2 systematic reviews, 2 randomised open label trials, one longitudinal study and one retrospective cohort study.
conclusionsEfficacy and toxicity for MTX appear related to absorbed dose of MTX, not to route of administration. While bioavailability is greater for parenteral MTX, there is no evidence yet that splitting the oral dose of MTX is less advantageous, less safe or less tolerable than administering parenteral MTX. However, there appear to be modest benefits in beginning with higher doses of MTX, and switching to parenteral MTX when the clinical response to an oral dose is inadequate.
Indexed as
Identifiers
25536122PMC4406815W2224232303What OpenQuestion holds
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.