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Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Clin+Exp+Rheumatol 2015 ; 33 (2): 272-8 Nephropedia Template TP
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Outcomes Related to Methotrexate Dose and Route of Administration in Patients with Rheumatoid Arthritis: A Systematic Literature Review #MMPMID25536122
Goodman SM; Cronstein BN; Bykerk VP
Clin Exp Rheumatol 2015[Mar]; 33 (2): 272-8 PMID25536122show ga
Objective: Methotrexate (MTX) is considered the ?anchor drug? in the therapy of rheumatoid arthritis (RA), yet many physicians do not optimize MTX regimens in spite of high RA disease activity. The recent development of an auto-injector for the subcutaneous (subQ) administration of MTX has prompted re-evaluation of MTX utilization. The purpose of this systematic literature review is to determine the optimal dose, drug level, and route of administration for MTX in the context of relevant pharmacokinetics and pharmacogenomics. Methods: A systematic literature review was performed in Medline searching specifically for randomized controlled trials, systematic reviews, case control and cohort studies evaluating outcomes related to MTX dose and route of administration. Articles fulfilling these inclusion criteria were reviewed. Data on MTX dose, route of administration, clinical response, drug levels and adverse events were evaluated. Results: Our search identified 420 articles of which 6 were eligible for inclusion using the above criteria. These included 2 systematic reviews, 2 randomized open label trials, one longitudinal study and one retrospective cohort study. Conclusion: Efficacy and toxicity for MTX appear related to absorbed dose of MTX, not to route of administration. While bioavailability is greater for parenteral MTX, there is no evidence yet that splitting the oral dose of MTX is less advantageous, safer or more tolerable than administering parenteral MTX. However, there appear to be modest benefits in beginning with higher doses of MTX, and switching to parenteral MTX when the clinical response to an oral dose is inadequate.