Abstract
ObjectiveStudies suggest that parenteral MTX may be more efficacious than the oral form at equivalent doses for the treatment of rheumatoid arthritis. We carried out a meta-analysis to compare the efficacy of oral versus parenteral MTX in RA.MethodsPubMed, Web of Science and Embase were systematically searched from inception to June 8th 2017 and reviewed following PRISMA 2009 guidelines, by two independent reviewers. To be included, trials had to study adults with RA randomized to the same dose of either oral or parenteral MTX. The primary endpoint was ACR20 at 6 months. Intention-to-treat analysis results were used when possible. Data from direct comparisons between oral and parenteral methotrexate quantitatively analyzed using maximum likelihood random effects meta-analysis. Relative treatment effects were generated as an odds ratio [OR] (OR>1 indicated a benefit for parenteral therapy).ResultsThe search yielded 357 papers or abstracts. After review of titles or abstracts and full text papers, we found 4 that met inclusion criteria with 703 patients randomized. Dose of MTX started at 15mg/week and increased up to 25mg/week. The summary OR for achieving ACR20 using parenteral vs. oral MTX was 3.02 (95% CI 1.41, 6.46), with no significant difference in the risk for all adverse events.ConclusionParenteral MTX therapy had significantly higher odds than oral MTX of achieving reduction in disease activity. We propose that parenteral MTX is more effective than weekly oral MTX; its widespread use may lead to better control of disease and a decrease in demand for biologic agents.
Highlights
The summary OR for achieving ACR20 using parenteral vs. oral MTX was 3.02, with no significant difference in the risk for all adverse events
Oral versus parenteral methotrexate its widespread use may lead to better control of disease and a decrease in demand for biologic agents
Rheumatoid arthritis is a chronic autoimmune inflammatory disease, with an estimated annual incidence of 50 per 100,000 and prevalence of approximately 0.8% [1] [2] [3], that results in a significant socioeconomic burden
Summary
Rheumatoid arthritis is a chronic autoimmune inflammatory disease, with an estimated annual incidence of 50 per 100,000 and prevalence of approximately 0.8% [1] [2] [3], that results in a significant socioeconomic burden. Management of RA has changed significantly over the years, as breakthroughs in the understanding of disease pathogenesis have led to a tremendous growth in the number of available treatments. ACR and EULAR updated their RA management guidelines to provide similar treatment algorithms, both recommending Methotrexate monotherapy as the first strategy for early RA [4] [5]. EULAR and ACR recommendations are to increase the Methotrexate dose until disease control has been achieved, and up to 25 mg daily. These practice guidelines recommend considering other conventional DMARDs or changing to biologics if response to MTX is suboptimal
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