title: Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide.
abstract: OBJECTIVE
  Although glucocorticosteroids are considered the first-line treatment in sarcoidosis, refractory cases require alternatives, such as methotrexate (MTX). The aim of this study was to develop, on behalf of the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG), multinational evidence-based recommendations for the use of MTX in sarcoidosis for routine clinical practice.
  
  
  RESULTS
  A systematic literature search was conducted and combined with the opinions of sarcoidosis experts worldwide to formulate the recommendations. An online survey concerning 10 clinical questions was sent through the WASOG newsletter to sarcoidosis experts. Agreement about the recommendations amongst the world's leading sarcoidologists was evaluated. A total of 237 articles were identified, 43 of which were included. Randomized controlled trial evidence supporting the use of MTX in sarcoidosis was limited. Forty-five per cent (113 of 250) of the sarcoidosis experts contacted completed the survey (Europe 55%, North America 26% and Asia 12%). Ten recommendations were formulated concerning the indications for use, starting dose, folic acid, work-up, contraindications, monitoring, administration options in case of adverse gastrointestinal effects, hepatotoxicity, long-term safety and use during pregnancy and breast feeding.
  
  
  CONCLUSIONS
  Ten multinational evidence-based recommendations for the use of MTX in sarcoidosis were developed, which are supported by the world's foremost sarcoidosis experts.
authors.affiliation: Department of Interstitial Lung Diseases, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Johanna P
authors.initials: JP
authors.lastname: Cremers
authors.forename: Marjolein
authors.initials: M
authors.lastname: Drent
authors.forename: Aalt
authors.initials: A
authors.lastname: Bast
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Shigemitsu
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.forename: Nadera J
authors.initials: NJ
authors.lastname: Sweiss
authors.forename: Tim L
authors.initials: TL
authors.lastname: Jansen
mesh_terms: D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D006801:Humans; D007390:International Agencies; D008727:Methotrexate / Q000627:therapeutic use*; D012507:Sarcoidosis / Q000188:drug therapy*; D013038:Specialization; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D008727:Methotrexate