Tornero Molina Jesús, Calvo Alen Jaime, Ballina Javier, Belmonte María Ángeles, Blanco Francisco J, Caracuel Miguel Ángel, Carbonell Jordi, Corominas Héctor, Chamizo Eugenio, Hidalgo Cristina, Ivorra José Román, Marenco José Luis, Moreno Muelas José Vicente, Muñoz-Fernández Santiago, Nolla Joan M, Pérez Trinidad, Sanmarti Raimon, Trenor Pilar, Urrego Claudia, Vidal Javier, Rosas Gomez de Salazar José
Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España.
Hospital Universitario Araba, Vitoria, España.
Reumatol Clin (Engl Ed). 2018 May-Jun;14(3):142-149. doi: 10.1016/j.reuma.2016.12.001. Epub 2017 Jan 9.
To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience.
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 was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on 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 were 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).
Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text.
The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
基于最佳证据和经验，制定关于肠外使用甲氨蝶呤（MTX）治疗风湿性疾病（主要是类风湿关节炎）的建议。
挑选了一组21位肠外使用MTX的专家。协调员提出了13个关于肠外使用MTX的问题（适应证、疗效、安全性和成本效益）。进行了系统评价以回答这些问题。利用这些信息，制定了纳入和排除标准以及检索策略（涉及医学文献数据库、荷兰医学文摘数据库和考克兰图书馆）。三名不同的评审员筛选文章。创建了证据表。对欧洲抗风湿病联盟（EULAR）和美国风湿病学会（ACR）的摘要进行了评估。基于这些证据，协调员提出了初步建议，专家们在一次名义群体会议上进行了讨论和投票。使用牛津循证医学中心的方法以及德尔菲技术（两轮）确定证据水平和推荐等级。如果至少80%的专家投赞成票（赞成/反对），则达成共识。
大多数证据涉及类风湿关节炎。共提出了13条关于肠外使用MTX的初步建议；其中11条被接受。13条中有2条未进行投票，在正文中进行了评论。
本手稿旨在解决常见问题，并在使用肠外MTX治疗患者时帮助制定决策策略。
