Evidence map›Paper›PMID 28435338›Full record

ReviewOpen access rheumatology : research and reviews2017

Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis.

Alfonso E Bello, Elizabeth L Perkins, Randy Jay, Petros Efthimiou

Registry-linked trialOpen access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Open access rheumatology : research and reviews, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06123403 (Evaluation of High Dose Methotrexate Toxicity in Correlation With Blood Methotrexate Level and the Role of Cystatin C in Prediction of Acute Kidney Injury in Pediatric Malignancies), which is not on this map. Cited by 40 papers.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed
9.7field-weighted citation impact, top 1% 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.

NCT06123403 unknown statusnot on this mapstarted 2024, after this paper: background citation

Evaluation of High Dose Methotrexate Toxicity in Correlation With Blood Methotrexate Level and the Role of Cystatin C in Prediction of Acute Kidney Injury in Pediatric Malignancies

TypeobservationalSponsorSohag UniversityRan2024 to 2025Enrolled100ConditionsMethotrexate ToxicityArmsblood methotrexate level and Cystatin C level
3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 108 citations in OpenAlex.

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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

4 authors at 3 institutions in 1 country.

Alfonso E BelloIllinois Bone & Joint Institute, Glenview, IL.
Elizabeth L PerkinsRheumatology Care Center, Birmingham, AL.
Randy JayArizona Arthritis & Rheumatology Associates, Phoenix, AZ.
Petros EfthimiouDivision of Rheumatology, New York Methodist Hospital, Brooklyn, NY, USA.
Arthritis and Rheumatism Associates · USIllinois Bone and Joint Institute · USNewYork–Presbyterian Brooklyn Methodist Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Methotrexate (MTX) remains the cornerstone therapy for patients with rheumatoid arthritis (RA), with well-established safety and efficacy profiles and support in international guidelines. Clinical and radiologic results indicate benefits of MTX monotherapy and combination with other agents, yet patients may not receive optimal dosing, duration, or route of administration to maximize their response to this drug. This review highlights best practices for MTX use in RA patients. First, to improve the response to oral MTX, a high initial dose should be administered followed by rapid titration. Importantly, this approach does not appear to compromise safety or tolerability for patients. Treatment with oral MTX, with appropriate dose titration, then should be continued for at least 6 months (as long as the patient experiences some response to treatment within 3 months) to achieve an accurate assessment of treatment efficacy. If oral MTX treatment fails due to intolerability or inadequate response, the patient may be "rescued" by switching to subcutaneous delivery of MTX. Consideration should also be given to starting with subcutaneous MTX given its favorable bioavailability and pharmacodynamic profile over oral delivery. Either initiation of subcutaneous MTX therapy or switching from oral to subcutaneous administration improves persistence with treatment. Upon transition from oral to subcutaneous delivery, MTX dosage should be maintained, rather than increased, and titration should be performed as needed. Similarly, if another RA treatment is necessary to control the disease, the MTX dosage and route of administration should be maintained, with titration as needed.

Indexed as

bioavailabilitydosinggastrointestinalpolyglutamationsubcutaneous

Identifiers

PMID28435338
PMCPMC5386601
OpenAlexW2597733778

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.