Österreichische Empfehlungen zum Gebrauch von Methotrexat in der Rheumatologie – Expertenkonsensus basierend auf einer systematischen Literatursuche

Zusammenfassung

Methotrexat wird als Goldstandard Medikament bei der Rheumatoiden Arthritis häufig eingesetzt. Um Unklarheiten in der Anwendung – insbesondere in speziellen Situationen – zu beseitigen, liegen nun Empfehlungen für die Verwendung von Methotrexat bei rheumatologischen Erkrankungen in der täglichen Praxis vor. Im Rahmen des internationalen 3E Projekts wählten Experten 13 Fragen zum Thema Methotrexat in der Rheumatologie aus. Für jede Frage wurde eine systematische Literatursuche mit vordefinierten Ein- und Ausschlusskriterien durchgeführt. 10 Fragen wurden im Rahmen eines internationalen Projekts behandelt, zusätzlich wurden 3 Fragen auf nationaler Ebene ausgearbeitet. Anschließend stimmten österreichische Experten über Formulierung der Antworten ab. Der Grad der Zustimmung wurde dokumentiert und die Antworten nach Evidenzgrad klassifiziert. Um die Umsetzung der Empfehlung in der täglichen Praxis zu evaluieren, wurde anschließend eine anonyme Umfrage unter den praktizierenden Rheumatologen mittels Fragebogen durchgeführt und ausgewertet. Es zeigte sich, dass die Empfehlungen bereits jetzt in der Praxis umgesetzt werden. Der Artikel bringt einen Überblick über die Empfehlungen der österreichischen Experten als auch Einblick in die Ergebnisse der Systematischen Literatursuche zu den einzelnen Fragen. Zusätzlich erfolgt ein Vergleich zwischen den österreichischen, deutschen und internationalen Empfehlungen.

Abstract

Methotrexate (MTX) is commonly used in rheumatological disorders and is the first-line treatment in rheumatoid arthritis. To improve MTX therapy and standardise treatment, recommendations were established on a national basis. An Austrian expert panel retrieved 13 questions by a Delphi process including topics such as work-up, monitoring, safety, dosing, pregnancy, surgery as well as pulmonary toxicity, infection and vaccination under MTX treatment. A systematic literature review was performed for each question categorising according to the Oxford level of evidence. On the basis of the evidence 20 Austrian experts discussed the results and formulated recommendations. Finally, internal approval was assessed as well as external validity; the latter was done by an anonymous questionnaire asking practising rheumatologists for their agreement with the recommendations and their practical value. The article summarises the 13 recommendations with the relevant evidence. Additionally we show internal and external agreement with the elaborated recommendations as well as a comparison of the Austrian, German and Multinational 3e recommendations for the use of methotrexate in rheumatic disorders in every day clinical practice.

Schlüsselwörter

Methotrexat - Empfehlung - Rheumatoide Arthritis

Key words

methotrexate - recommendations - rheumatoid arthritis

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