ACR Annual Meeting: Methotrexate should be continued in most patients with active rheumatoid arthritis when biologic or targeted synthetic therapy is initiated, EU researchers reported in a poster presentation on November 12 at the annual meeting of the American College of Rheumatology in Atlanta.
Methotrexate should be continued in most patients with active rheumatoid arthritis when biologic or targeted synthetic therapy is initiated, EU researchers reported in a poster presentation on November 12 at the annual meeting of the American College of Rheumatology in Atlanta.
This is the main message of 10 new consensus statement recommendations for EU rheumatologists made by a panel of Spanish experts and presented by JesÃºs Tornero, M.D., chief of the Section of Rheumatology at the Hospital Universitario de Guadalajara. American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) guidelines for rheumatoid arthritis currently recommend adding a biologic to methotrexate when disease activity remains moderate to high. Many patients, however, stop methotrexate when starting these agents.
The Spanish panel reviewed relevant EULAR, ACR, and international guidelines and conducted a systematic literature review to answer questions about combination therapy for rheumatoid arthritis with methotrexate plus a biologic or targeted synthetic.
They restricted searches to English or Spanish-language systematic reviews and meta-analyses with data on efficacy or safety variables in patients with RA on or considering initiating methotrexate plus a biologic or targeted synthetic. The panel included 61 papers in their final review and evaluated evidence quality with Oxford Center for Evidence-based Medicine standards, which they also used to assign evidence level and grade to their final recommendations.
Experts voted yes or no on proposed recommendations, reaching 100% agreement for all but two, which had 91% agreement. Most had a 1b level of evidence (based on a single randomized controlled trial with a narrow confidence interval) and many received an A grade (consistent level 1 studies).
REFERENCE“2386 - Consensus Statement and Recommendations on Methotrexate Use in Combined Therapy with Biological or Targeted Synthetic Disease Modifying Drugs in Patients with Rheumatoid Arthritis,” JesÃºs Tornero, MD, 9 a.m., Nov 12. American College of Rheumatology 2019 annual meeting, Atlanta.