title: Methotrexate in systemic lupus erythematosus: a systematic review of its efficacy.
abstract: OBJECTIVE
  The objective of this review is to evaluate the evidence for efficacy of methotrexate (MTX) in systemic lupus erythematosus (SLE).
  
  
  METHODS
  A comprehensive, computerized search was performed in MEDLINE (PubMed), EMBASE and the Cochrane Controlled Trials registry to screen for studies that examined the efficacy of MTX in adult SLE patients. The Jadad scoring system was used to assess study quality, and data were pooled using the random effects model.
  
  
  RESULTS
  Of the 53 articles that were identified, 44 were excluded. Nine studies (including three randomized controlled and six observational) were eligible for inclusion. All of the included studies predominantly involved patients with arthritis or mucocutaneous features. There was significant reduction of the SLE Disease Activity Index (SLEDAI) among MTX-treated patients when compared with controls (p = 0.001, odds ratio (OR) 0.444, 95% confidence interval (CI) 0.279 to 0.707). There was also significant reduction in the average dose of corticosteroids among MTX-treated patients when compared with controls (p = 0.001, OR 0.335, 95% CI 0.202 to 0.558). The effect of MTX on laboratory and serological markers, including erythrocyte sedimentation rate, anti-dsDNA and complement levels (C3 and C4), could not be determined because of the limited numbers of controlled trials.
  
  
  CONCLUSIONS
  The use of MTX is associated with significant reductions in SLEDAI and the average dose of corticosteroids in adult patients with SLE.
authors.affiliation: 1Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia.
authors.forename: R
authors.initials: R
authors.lastname: Sakthiswary
authors.forename: E
authors.initials: E
authors.lastname: Suresh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D008727:Methotrexate / Q000627:therapeutic use*; D016017:Odds Ratio; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007166:Immunosuppressive Agents; D008727:Methotrexate
keywords: SLE; Systemic lupus erythematosus; efficacy; lupus; methotrexate