Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

K. Visser; W. Katchamart; E. Loza; J. A. Martinez-Lopez; C. Salliot; J. Trudeau; C. Bombardier; L. Carmona; D. van der Heijde; J. W. J. Bijlsma; D. T. Boumpas; H. Canhao; C. J. Edwards; V. Hamuryudan; T. K. Kvien; B. F. Leeb; E. M. Martín-Mola; H. Mielants; U. Müller-Ladner; G. Murphy; M. Østergaard; I. A. Pereira; C. Ramos-Remus; G. Valentini; J. Zochling; M. Dougados

doi:10.1136/ard.2008.094474

Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

K. Visser^*
, W. Katchamart
, E. Loza
, J. A. Martinez-Lopez
, C. Salliot
, J. Trudeau
, C. Bombardier
, L. Carmona
, D. van der Heijde
, J. W. J. Bijlsma
, D. T. Boumpas
, H. Canhao
, C. J. Edwards
, V. Hamuryudan
, T. K. Kvien
, B. F. Leeb
, E. M. Martín-Mola
, H. Mielants
, U. Müller-Ladner
, G. Murphy

M. Østergaard, I. A. Pereira, C. Ramos-Remus, G. Valentini, J. Zochling, M. Dougados

^*Corresponding author for this work

Leiden University Medical Center
University of Toronto
Hospital Clínico San Carlos de Madrid
Research Unit, Spanish Society of Rheumatology, Madrid, Spain
Université Paris Cité
Hôpital Notre-Dame
Health Network Research Institute
University Medical Center Utrecht
University of Crete
University of Lisbon
Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria/Centro Hospitalar Lisboa Norte, Lisboa, Portugal
University Hospital Southampton NHS Foundation Trust
Istanbul University - Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, 34320, Turkey
Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
State Hospital Stockerau
Hospital Universitario La Paz
Ghent University
Justus Liebig University Giessen
University College Cork
University of Copenhagen
Universidade Federal de Santa Catarina
Unidad de Investigación en Enfermedades Crónico-Degenerativas
University of Naples Federico II
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Research output: Contribution to journal › Review article › Academic › peer-review

Abstract

Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007-8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005-7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroidsparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.

Original language	English
Pages (from-to)	1086-1093
Journal	Annals of the rheumatic diseases
Volume	68
Issue number	7
DOIs	https://doi.org/10.1136/ard.2008.094474
Publication status	Published - 2009
Externally published	Yes

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Visser, K., Katchamart, W., Loza, E., Martinez-Lopez, J. A., Salliot, C., Trudeau, J., Bombardier, C., Carmona, L., van der Heijde, D., Bijlsma, J. W. J., Boumpas, D. T., Canhao, H., Edwards, C. J., Hamuryudan, V., Kvien, T. K., Leeb, B. F., Martín-Mola, E. M., Mielants, H., Müller-Ladner, U., ... Dougados, M. (2009). Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Annals of the rheumatic diseases, 68(7), 1086-1093. https://doi.org/10.1136/ard.2008.094474

Visser, K. ; Katchamart, W. ; Loza, E. et al. / Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis : Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. In: Annals of the rheumatic diseases. 2009 ; Vol. 68, No. 7. pp. 1086-1093.

@article{bd67a702051347c6813889bf7620d58e,

title = "Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative",

abstract = "Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007-8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005-7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroidsparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.",

author = "K. Visser and W. Katchamart and E. Loza and Martinez-Lopez, \{J. A.\} and C. Salliot and J. Trudeau and C. Bombardier and L. Carmona and \{van der Heijde\}, D. and Bijlsma, \{J. W. J.\} and Boumpas, \{D. T.\} and H. Canhao and Edwards, \{C. J.\} and V. Hamuryudan and Kvien, \{T. K.\} and Leeb, \{B. F.\} and Mart{\'i}n-Mola, \{E. M.\} and H. Mielants and U. M{\"u}ller-Ladner and G. Murphy and M. {\O}stergaard and Pereira, \{I. A.\} and C. Ramos-Remus and G. Valentini and J. Zochling and M. Dougados",

year = "2009",

doi = "10.1136/ard.2008.094474",

language = "English",

volume = "68",

pages = "1086--1093",

journal = "Annals of the rheumatic diseases",

issn = "0003-4967",

publisher = "BMJ Publishing Group",

number = "7",

}

Visser, K, Katchamart, W, Loza, E, Martinez-Lopez, JA, Salliot, C, Trudeau, J, Bombardier, C, Carmona, L, van der Heijde, D, Bijlsma, JWJ, Boumpas, DT, Canhao, H, Edwards, CJ, Hamuryudan, V, Kvien, TK, Leeb, BF, Martín-Mola, EM, Mielants, H, Müller-Ladner, U, Murphy, G, Østergaard, M, Pereira, IA, Ramos-Remus, C, Valentini, G, Zochling, J & Dougados, M 2009, 'Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative', Annals of the rheumatic diseases, vol. 68, no. 7, pp. 1086-1093. https://doi.org/10.1136/ard.2008.094474

Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. / Visser, K.; Katchamart, W.; Loza, E. et al.
In: Annals of the rheumatic diseases, Vol. 68, No. 7, 2009, p. 1086-1093.

Research output: Contribution to journal › Review article › Academic › peer-review

TY - JOUR

T1 - Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis

T2 - Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

AU - Visser, K.

AU - Katchamart, W.

AU - Loza, E.

AU - Martinez-Lopez, J. A.

AU - Salliot, C.

AU - Trudeau, J.

AU - Bombardier, C.

AU - Carmona, L.

AU - van der Heijde, D.

AU - Bijlsma, J. W. J.

AU - Boumpas, D. T.

AU - Canhao, H.

AU - Edwards, C. J.

AU - Hamuryudan, V.

AU - Kvien, T. K.

AU - Leeb, B. F.

AU - Martín-Mola, E. M.

AU - Mielants, H.

AU - Müller-Ladner, U.

AU - Murphy, G.

AU - Østergaard, M.

AU - Pereira, I. A.

AU - Ramos-Remus, C.

AU - Valentini, G.

AU - Zochling, J.

AU - Dougados, M.

PY - 2009

Y1 - 2009

N2 - Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007-8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005-7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroidsparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.

AB - Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007-8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005-7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroidsparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use.

UR - https://www.scopus.com/pages/publications/67549096874

UR - https://www.ncbi.nlm.nih.gov/pubmed/19033291

U2 - 10.1136/ard.2008.094474

DO - 10.1136/ard.2008.094474

M3 - Review article

C2 - 19033291

SN - 0003-4967

VL - 68

SP - 1086

EP - 1093

JO - Annals of the rheumatic diseases

JF - Annals of the rheumatic diseases

IS - 7

ER -

Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Annals of the rheumatic diseases. 2009;68(7):1086-1093. doi: 10.1136/ard.2008.094474

Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: Integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

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