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2021 Rheumatoid Arthritis Guidelines Pocket Guide

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5 Table 3. Methotrexate Administration Recommendations Certainty of Evidence For patients initiating methotrexate, oral methotrexate is conditionally recommended over subcutaneous methotrexate. Moderate Initiation/titration of methotrexate to a weekly dose of at least 15 mg within four to six weeks is conditionally recommended over initiation/titration to a weekly dose of less than 15 mg. a Moderate / Very low b For patients not tolerating oral methotrexate, split dose of oral methotrexate over 24 hours or switch to subcutaneous injections, and/or an increased dose of folic/folinic acid, is conditionally recommended over a switch to alternative DMARD(s). Very low For patients taking oral methotrexate who are not at target, a switch to subcutaneous methotrexate is conditionally recommended over addition/switch to alternative DMARD(s). Very low a is recommendation refers only to the initial prescribing of methotrexate and is not meant to limit further dose escalation which oen provides additional efficacy. b e first certainty of evidence applies to the first listed option; the second certainty of evidence applies to the second option.

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