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.
