ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2510

Recommendations for the Use of Parenteral Methotrexate in Rheumatic Diseases

Jesús Tornero Molina1, Jaime Calvo2, Francisco Javier Ballina-García3, María Ángeles Belmonte4, Francisco J. Blanco5,6, Miguel Angel Caracuel-Ruiz7, Jordi Carbonell8, Hector Corominas9, Eugenio Chamizo Carmona10, C. Hidalgo-Calleja11, Jose Andres Roman Ivorra12, José Luis Marenco de la Fuente13, J.V. Moreno14, Santiago Muñoz Fernandez15, Joan Miquel Nolla16, Trinidad Perez Sandoval17, Raimon Sanmarti18, Pilar Trenor19, Claudia Urrego20, Javier Vidal1 and José Rosas21, 1Rheumatology Unit, Hospital de Guadalajara, Guadalajara, Spain, 2Rheumatology Unit, Hospital Universitario Araba, Vitoria-Gasteiz, Spain, 3Department of Rheumatology, Hospital Universitario Central de Asturias, Asturias, Spain, 4Rheumatology service, Hospital Regional Universitario Carlos Haya, Malaga, Spain, 5Osteoarticular and Aging Research Lab, INIBIC –Complejo Hospitalario Universitario A Coruña, A Coruña, Spain, 6Rheumatology Division, INIBIC-Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain, 7Rheumatology service, IMIBIC/Reina Sofia Hospital/University of Cordoba, Córdoba, Spain, 8Rheumatology Unit, Hospital del Mar, Barcelona, Spain, 9Rheumatology, Hospital Moises Broggi, Barcelona, Spain, 10Rheumatology, Hospital de Mérida, Mérida, Spain, 11University of Salamanca Hospital, Salamanca, Spain, 12Department of Rheumatology, Hospital Universitario y Politecnico La Fe, Valencia, Spain, 13Rheumatology, Hospital de Valme, Seville, Spain, 14Rheumatologist. Vall D’Hebron Hospital, Barcelona, Spain, 15Rheumatology, Hospital Infanta Sofía, Madrid, Spain, 16Rheumatology, Bellvitge University Hospital, Barcelona, Spain, 17Rheumatology, Hospital de León, LEÓN, Spain, 18Rheumatology Department, Hospital Clínic de Barcelona, Barcelona, Spain, 19Rheumatology Unit, Hospital Clínico de Valencia, Valencia, Spain, 20Hospital G. Segovia, Segovia, Spain, 21Rheumatology, Hospital Marina Baixa, Villajoyosa (Alicante), Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: To develop recommendations for the management of parenteral MTX in rheumatic diseases based on best evidence and experience.

Methods: A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review were performed in order to answer the questions. Using this information, inclusion and exclusion criteria were stablishes as well as the search strategies (Medline, Embase and the Cochrane Library were searched). Three different reviewers selected the articles. Evidence tables were produced. At the same time, EULAR and ACR abstracts were evaluates. With this evidence the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).

Results:  A total of 13 preliminary recommendations on the use of parenteral MTX were proposed of which 11 were accepted (see table). Two were not voted and were explained in the main text of the document.

Conclusion: This document pretends to help solve usual clinical questions and facilitate decision making when treating rheumatic patients with parenteral MTX. Table. Recommendations and their level of evidence (LE), grade of recommendation (GR) and grade of agreement (GA).

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RECOMMENDATION

LE; GR; GA

1

Parenteral MTX biodisponibility compared with oral MTX is superior, mainly if the dose is ≥15 mg/w

NE 2b; GR B-C; GA 100%

2

In MTX-naïve patients, parenteral MTX efficacy compared with oral MTX is superior (doses of 15 mg/w)

NE 1b; GR A; GA 94%

3

In patients refractory to oral MTX (15 mg/w) the efficacy of dose escalation is higher with parenteral MTX

NE 2a; GR B; GA 94%

4

Safety profile and tolerability of parenteral MTX is similar to oral MTX

NE 1b; GR B; GA 100%

5

It is recommended to use parenteral MTX in patients with high disease activity, in those with low adherence to oral MTX, polypharmacy, obese patients, in order to avoid dosing errors, and always taking into account patients preferences

NE 4; GR D; GA 100%

6

It is recommended to initiate, increase and decrease parenteral MTX the same way as with oral MTX

NE 5; GR D; GA 81%

7

It is recommended to increase parenteral MTX dose up to 25-30 mg/w

NE 5; GR D; GA 88%

8

According to available pharmacokinetic data, the dose conversion between oral and parenteral dose would be: up to 15 mg/w the same dose, 20 mg of oral MTX would be 15 mg of parenteral MTX and for 25 mg of oral MTX, 20 mg of parenteral MTX

NE 2b; GR B; GA 100%

9

Subcutaneous MTX could be cost-effective in early RA naive to MTX

NE 2a; GR B; GA 94%

10

Parenteral MTX might increase patients adherence to MTX

NE 2b; GR B; GA 94%

11

Self-administration education provides a high adherence to treatment, satisfaction, patients autonomy and improves and adequate administration

NE 2b; GR B; GA 100%

Disclosure: J. Tornero Molina, None; J. Calvo, None; F. J. Ballina-García, None; M. Á. Belmonte, None; F. J. Blanco, None; M. A. Caracuel-Ruiz, None; J. Carbonell, None; H. Corominas, None; E. Chamizo Carmona, None; C. Hidalgo-Calleja, None; J. A. Roman Ivorra, None; J. L. Marenco de la Fuente, None; J. V. Moreno, None; S. Muñoz Fernandez, None; J. M. Nolla, None; T. Perez Sandoval, None; R. Sanmarti, None; P. Trenor, None; C. Urrego, None; J. Vidal, None; J. Rosas, None.

To cite this abstract in AMA style:

Tornero Molina J, Calvo J, Ballina-García FJ, Belmonte MÁ, Blanco FJ, Caracuel-Ruiz MA, Carbonell J, Corominas H, Chamizo Carmona E, Hidalgo-Calleja C, Roman Ivorra JA, Marenco de la Fuente JL, Moreno JV, Muñoz Fernandez S, Nolla JM, Perez Sandoval T, Sanmarti R, Trenor P, Urrego C, Vidal J, Rosas J. Recommendations for the Use of Parenteral Methotrexate in Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/recommendations-for-the-use-of-parenteral-methotrexate-in-rheumatic-diseases/. Accessed .

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