Canadian recommendations for use of methotrexate in patients with rheumatoid arthritis.
OBJECTIVE
To develop recommendations for the use of methotrexate (MTX) in patients with rheumatoid arthritis.


METHODS
Canadian rheumatologists who participated in the international 3e Initiative in Rheumatology (evidence, expertise, exchange) in 2007-2008 formulated 5 unique Canadian questions. A bibliographic team systematically reviewed the relevant literature on these 5 topics. An expert committee consisting of 26 rheumatologists from across Canada was convened, and a set of recommendations was proposed based on the results of systematic reviews combined with expert opinions using a nominal group consensus process.


RESULTS
The 5 questions addressed drug interactions, predictors of response, strategies to reduce non-serious side effects, variables to assess clinical response, and incorporating patient preference into decision-making. The systematic review retrieved 93 pertinent articles; this evidence was presented to the expert committee during the interactive workshop. After extensive discussion and voting, a total of 9 recommendations were formulated: 2 on drug interactions, 1 on predictors of response, 2 on strategies to reduce non-serious side effects, 3 on variables to assess clinical response, and 1 on incorporating patient preferences into decision-making. The level of evidence and the strength of recommendations are reported. Agreement among panelists ranged from 85% to 100%.


CONCLUSIONS
Nine recommendations pertaining to the use of MTX in daily practice were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement.
Katchamart
Wanruchada
W
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Bourré-Tessier
Josiane
J
Donka
Timea
T
Drouin
Julie
J
Rohekar
Gina
G
Bykerk
Vivian P
VP
Haraoui
Boulos
B
Leclerq
Sharon
S
Mosher
Dianne P
DP
Pope
Janet E
JE
Shojania
Kam
K
Thomson
John
J
Thorne
J Carter
JC
Bombardier
Claire
C
D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D019317:Evidence-Based Medicine; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D012219:Rheumatology / Q000592:standards
D018501:Antirheumatic Agents; D008727:Methotrexate