PT  - JOURNAL ARTICLE
AU  - J Fransen
AU  - R F J M Laan
AU  - M A F J van der Laar
AU  - T W J Huizinga
AU  - P L C M van Riel
TI  - Influence of guideline adherence on outcome in a randomised controlled trial on the efficacy of methotrexate with folate supplementation in rheumatoid arthritis
AID  - 10.1136/ard.2003.018861
DP  - 2004 Oct 01
TA  - Annals of the Rheumatic Diseases
PG  - 1222--1226
VI  - 63
IP  - 10
4099  - http://ard.bmj.com/content/63/10/1222.short
4100  - http://ard.bmj.com/content/63/10/1222.full
SO  - Ann Rheum Dis2004 Oct 01; 63
AB  - Objective: To study the influence of rheumatologists’ adherence to a methotrexate guideline on efficacy and toxicity in the treatment of rheumatoid arthritis.Methods: In a 48 week randomised controlled trial of methotrexate, comparing folates with placebo, rheumatologists were advised on methotrexate dosage using a guideline reflecting daily practice. The influence of guideline non-adherence on outcome was analysed using generalised estimating equations and survival analysis.Results: In 51% of the 411 study patients the guidelines were always followed. Non-adherence resulted in lower doses of methotrexate in 25% of cases, and higher doses in 24%. The reduction in the disease activity score was significantly greater (mean −0.4; p = 0.0085) in the adherent group than in the “low dose” group; the “high dose” group did not differ from the adherent group. Dropout caused by severe adverse events did not differ between the three groups.Conclusions: There is an indication that adherence to guidelines on methotrexate dosage may benefit patients with rheumatoid arthritis by improving disease activity without increasing toxicity. For definite proof, a randomised controlled trial comparing guideline supported dosing with usual care is needed.