Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis
Studies 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. PubMed, Web of Science and Embase were systematically searched fro...
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| Veröffentlicht in: | PloS one 2019-09, Vol.14 (9), p.e0221823 |
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| creator | Bujor, Andreea M Janjua, Sahar LaValley, Michael P Duran, Josefina Braun, Jürgen Felson, David T |
| description | Studies 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.
PubMed, 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).
The 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.
Parenteral 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. |
| doi_str_mv | 10.1371/journal.pone.0221823 |
| format | Article |
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PubMed, 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).
The 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.
Parenteral 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0221823</identifier><identifier>PMID: 31490947</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Administration, Oral ; Analysis ; Antiarthritic agents ; Antineoplastic agents ; Antirheumatic agents ; Arthritis ; Arthritis, Rheumatoid - drug therapy ; Bioavailability ; Biological weapons ; Biology and Life Sciences ; Care and treatment ; Clinical trials ; Diagnosis ; Disease control ; Drug dosages ; Drug therapy ; Humans ; Medicine ; Medicine and Health Sciences ; Meta-analysis ; Methotrexate ; Methotrexate - administration & dosage ; Physical Sciences ; Prevalence studies (Epidemiology) ; Randomization ; Research and Analysis Methods ; Rheumatoid arthritis ; Rheumatoid factor ; Studies ; Systematic review ; Therapy ; Treatment Outcome</subject><ispartof>PloS one, 2019-09, Vol.14 (9), p.e0221823</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Bujor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Bujor et al 2019 Bujor et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-9ba78e6b5f7be1c10c706735ab3891e1ea77a1d3aaf57953e68185e1b67c92943</citedby><cites>FETCH-LOGICAL-c758t-9ba78e6b5f7be1c10c706735ab3891e1ea77a1d3aaf57953e68185e1b67c92943</cites><orcidid>0000-0002-8840-8937</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731021/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731021/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31490947$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Kuwana, Masataka</contributor><creatorcontrib>Bujor, Andreea M</creatorcontrib><creatorcontrib>Janjua, Sahar</creatorcontrib><creatorcontrib>LaValley, Michael P</creatorcontrib><creatorcontrib>Duran, Josefina</creatorcontrib><creatorcontrib>Braun, Jürgen</creatorcontrib><creatorcontrib>Felson, David T</creatorcontrib><title>Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Studies 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.
PubMed, 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).
The 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.
Parenteral 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.</description><subject>Administration, Oral</subject><subject>Analysis</subject><subject>Antiarthritic agents</subject><subject>Antineoplastic agents</subject><subject>Antirheumatic agents</subject><subject>Arthritis</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Bioavailability</subject><subject>Biological weapons</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Diagnosis</subject><subject>Disease control</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Methotrexate</subject><subject>Methotrexate - administration & dosage</subject><subject>Physical Sciences</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Randomization</subject><subject>Research and Analysis Methods</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatoid factor</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Therapy</subject><subject>Treatment 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One</addtitle><date>2019-09-06</date><risdate>2019</risdate><volume>14</volume><issue>9</issue><spage>e0221823</spage><pages>e0221823-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Studies 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.
PubMed, 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).
The 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.
Parenteral 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31490947</pmid><doi>10.1371/journal.pone.0221823</doi><tpages>e0221823</tpages><orcidid>https://orcid.org/0000-0002-8840-8937</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Administration, Oral Analysis Antiarthritic agents Antineoplastic agents Antirheumatic agents Arthritis Arthritis, Rheumatoid - drug therapy Bioavailability Biological weapons Biology and Life Sciences Care and treatment Clinical trials Diagnosis Disease control Drug dosages Drug therapy Humans Medicine Medicine and Health Sciences Meta-analysis Methotrexate Methotrexate - administration & dosage Physical Sciences Prevalence studies (Epidemiology) Randomization Research and Analysis Methods Rheumatoid arthritis Rheumatoid factor Studies Systematic review Therapy Treatment Outcome |
| title | Comparison of oral versus parenteral methotrexate in the treatment of rheumatoid arthritis: A meta-analysis |
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