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Title: Canadian recommendations for use of methotrexate in patients with rheumatoid arthritis
Authors: Wanruchada Katchamart
Josiane Bourré-Tessier
Timea Donka
Julie Drouin
Gina Rohekar
Vivian P. Bykerk
Boulos Haraoui
Sharon LeClerq
Dianne P. Mosher
Janet E. Pope
Kam Shojania
John Thomson
J. Carter Thorne
Claire Bombardier
Kenneth Blocka
Cathy Elizabeth Flanagan
Paul Davis
Wojciech Olszynski
Vandana Ahluwalia
Michel Zummer
Gilles Boire
Jamie Henderson
Barry Koehler
Philip Baer
Zareen Ahmad
Anne St-Pierre
Martin Cohen
Maysan Abu-Hakima
Majed Khraishi
Elaine Soucy
Jacob Karsh
University of Toronto
Mahidol University
Centre Hospitalier de L'Universite de Montreal
Western University
University of Calgary
Dalhousie University
St. Joseph's Health Care London
The University of British Columbia
University of Ottawa, Canada
The Arthritis Program Research Group Inc.
Toronto General Research Institute University of Toronto
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Jul-2010
Citation: Journal of Rheumatology. Vol.37, No.7 (2010), 1422-1430
Abstract: Objective. To develop recommendations for the use of methotrexate (MTX) in patients with rheumatoid arthritis. Methods. Canadian rheumatologists who participated in the international 3e Initiative in Rheumatology (evidence, expertise, exchange) in 2007-2008 formulated 5 unique Canadian questions. A bibliographic team systematically reviewed the relevant literature on these 5 topics. An expert committee consisting of 26 rheumatologists from across Canada was convened, and a set of recommendations was proposed based on the results of systematic reviews combined with expert opinions using a nominal group consensus process. Results. The 5 questions addressed drug interactions, predictors of response, strategies to reduce non-serious side effects, variables to assess clinical response, and incorporating patient preference into decision-making. The systematic review retrieved 93 pertinent articles; this evidence was presented to the expert committee during the interactive workshop. After extensive discussion and voting, a total of 9 recommendations were formulated: 2 on drug interactions, 1 on predictors of response, 2 on strategies to reduce non-serious side effects, 3 on variables to assess clinical response, and 1 on incorporating patient preferences into decision-making. The level of evidence and the strength of recommendations are reported. Agreement among panelists ranged from 85% to 100%. Conclusion. Nine recommendations pertaining to the use of MTX in daily practice were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. The Journal of Rheumatology Copyright © 2010. All rights reserved.
ISSN: 0315162X
Appears in Collections:Scopus 2006-2010

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