Fang Wang5, Jingliang Tang2, Zhe Li3, Yanyan Qi4, Ganpeng Li4, Fang Wang5. 1. Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China. 2. School of Ethnic Medicine, State Ethnic Affairs Commission & Ministry of Education, Key Laboratory of Chemistry in Ethnic Medicinal Resources, Yunnan Minzu University, Kunming, 650500, Yunnan, People's Republic of China. 201562008240@sdu.edu.cn. 3. Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250100, People's Republic of China. 4. School of Ethnic Medicine, State Ethnic Affairs Commission & Ministry of Education, Key Laboratory of Chemistry in Ethnic Medicinal Resources, Yunnan Minzu University, Kunming, 650500, Yunnan, People's Republic of China. 5. School of Ethnic Medicine, State Ethnic Affairs Commission & Ministry of Education, Key Laboratory of Chemistry in Ethnic Medicinal Resources, Yunnan Minzu University, Kunming, 650500, Yunnan, People's Republic of China. 583234374@qq.com.
Abstract
OBJECTIVE: The most optimal route of methotrexate (MTX) administration for the treatment of rheumatoid arthritis (RA) has not yet been established. Our aim was to compare the efficacy, safety, and bioavailability profiles of oral MTX with parenteral MTX in adult patients with RA. METHODS: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalKey were searched for published randomized trials through December 30, 2021. Random-effects models were used to assess pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CIs). This review was registered in PROSPERO (number CRD42022297810). RESULTS: Of 705 identified trials, 6 met the criteria and were included in our meta-analysis (644 subjects). Compared to parenteral MTX, oral MTX yielded no significant differences in response rates of 20% (OR: 0.68; 95% CI: 0.40-1.75), 50% (OR: 0.75; 95% CI: 0.44-1.28), and 70% (OR: 0.75; 95% CI: 0.51-1.09) improvement according to American College of Rheumatology criteria (ACR20/50/70 response), and no increased relative risk of any adverse event (OR: 1.20; 95% CI: 0.49-2.93). Furthermore, parenteral MTX showed a significant advantage in the value of AUC0-t (MD: - 536.36; 95% CI: - 1054.22 to - 18.50), but not in Cmax (MD: - 12.86; 95% CI: - 84.30 to 58.58) and Tmax (MD: - 0.31; 95% CI: - 0.70 to 0.08) compared with oral MTX. CONCLUSION: Oral MTX at doses of 15-25 mg/week in active RA is not inferior to parenteral regarding efficacy and safety. This supports the initial therapy with oral MTX.
OBJECTIVE: The most optimal route of methotrexate (MTX) administration for the treatment of rheumatoid arthritis (RA) has not yet been established. Our aim was to compare the efficacy, safety, and bioavailability profiles of oral MTX with parenteral MTX in adult patients with RA. METHODS: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalKey were searched for published randomized trials through December 30, 2021. Random-effects models were used to assess pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CIs). This review was registered in PROSPERO (number CRD42022297810). RESULTS: Of 705 identified trials, 6 met the criteria and were included in our meta-analysis (644 subjects). Compared to parenteral MTX, oral MTX yielded no significant differences in response rates of 20% (OR: 0.68; 95% CI: 0.40-1.75), 50% (OR: 0.75; 95% CI: 0.44-1.28), and 70% (OR: 0.75; 95% CI: 0.51-1.09) improvement according to American College of Rheumatology criteria (ACR20/50/70 response), and no increased relative risk of any adverse event (OR: 1.20; 95% CI: 0.49-2.93). Furthermore, parenteral MTX showed a significant advantage in the value of AUC0-t (MD: - 536.36; 95% CI: - 1054.22 to - 18.50), but not in Cmax (MD: - 12.86; 95% CI: - 84.30 to 58.58) and Tmax (MD: - 0.31; 95% CI: - 0.70 to 0.08) compared with oral MTX. CONCLUSION: Oral MTX at doses of 15-25 mg/week in active RA is not inferior to parenteral regarding efficacy and safety. This supports the initial therapy with oral MTX.
Authors: Monique Hoekstra; Cees Haagsma; Cees Neef; Johannes Proost; Antonius Knuif; Mart van de Laar Journal: J Rheumatol Date: 2004-04 Impact factor: 4.666
Authors: J Braun; P Kästner; P Flaxenberg; J Währisch; P Hanke; W Demary; U von Hinüber; K Rockwitz; W Heitz; U Pichlmeier; C Guimbal-Schmolck; A Brandt Journal: Arthritis Rheum Date: 2008-01
Authors: M S Islam; S A Haq; M N Islam; A K Azad; M A Islam; R Barua; M M Hasan; M Mahmood; M Safiuddin; M M Rahman; M F Osmany; N Bari; R S Rumki; F B Rashid Journal: Mymensingh Med J Date: 2013-07
Authors: Monique Hoekstra; Cees Haagsma; Cees Neef; Johannes Proost; Antonius Knuif; Mart van de Laar Journal: J Rheumatol Date: 2006-01-15 Impact factor: 4.666
Authors: Josef S Smolen; Robert B M Landewé; Johannes W J Bijlsma; Gerd R Burmester; Maxime Dougados; Andreas Kerschbaumer; Iain B McInnes; Alexandre Sepriano; Ronald F van Vollenhoven; Maarten de Wit; Daniel Aletaha; Martin Aringer; John Askling; Alejandro Balsa; Maarten Boers; Alfons A den Broeder; Maya H Buch; Frank Buttgereit; Roberto Caporali; Mario Humberto Cardiel; Diederik De Cock; Catalin Codreanu; Maurizio Cutolo; Christopher John Edwards; Yvonne van Eijk-Hustings; Paul Emery; Axel Finckh; Laure Gossec; Jacques-Eric Gottenberg; Merete Lund Hetland; Tom W J Huizinga; Marios Koloumas; Zhanguo Li; Xavier Mariette; Ulf Müller-Ladner; Eduardo F Mysler; Jose A P da Silva; Gyula Poór; Janet E Pope; Andrea Rubbert-Roth; Adeline Ruyssen-Witrand; Kenneth G Saag; Anja Strangfeld; Tsutomu Takeuchi; Marieke Voshaar; René Westhovens; Désirée van der Heijde Journal: Ann Rheum Dis Date: 2020-01-22 Impact factor: 19.103