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specified dose was 15 mg/m2 (16.7%, 19/114). To simplify presentation of the MTX data, we converted the mg/m2 doses into mg/kg dose by assuming that the vignette patient was a 4.5-year-old girl who was at the 50% for weight (17 kg) and height (104.3 cm), giving her a body surface area of 0.7 m2 (weight and height values from the Centers for Disease Control girls 2–20 years growth chart, version 5/30/00, modified April 20, 2001, http://www.cdc.gov/growthcharts). The most commonly chosen MTX dose was 1 mg/kg weekly (39.5%), followed by 0.6 to 0.62 mg/kg (22.8%) and 0.5 mg/kg (18%) weekly. About 60% (71/114) of respondents specified separate MTX induction and maintenance treatment phases. The median induction phase duration was longer for those who specified 0.72 to 0.75 mg/kg/dose (9 months), 1.0 mg/kg/dose (6 months), or 0.6–0.62 mg/kg/dose (6 months) compared to other doses (2 to 2.5 months). However, the significance of this is not clear, as many respondents did not change the MTX dose or route of administration for the 2 phases. Some respondents may have divided MTX dosing into 2 phases based on the corticosteroid-dosing regimen. The median specified total MTX treatment duration was 24 months, with a range of 3 to 48 months. About 30% (32/114) of the respondents did not specify a treatment duration, stating that duration would be determined by the patient’s response to treatment. Although nearly all respondents (96%, 110/114) would also treat this patient with corticosteroids, there was great variability in recommended regimens. Slightly more PR (40%) specified treatment with only intravenous corticosteroids or methylprednisolone 30 mg/kg/dose (IV MP) versus only oral corticosteroids or prednisone (30%), or a combination of both oral and intravenous corticosteroid (combination corticosteroids, 27%; Table 2). Most of the respondents who specified combination corticosteroids or prednisone alone would follow an induction and maintenance regimen (90% and 65%, respectively), while only 38% of those using IV MP alone specified a separate maintenance regimen (data not shown). The most commonly specified initial corticosteroid dosing regimens were IV MP given 3 consecutive days monthly (29%), prednisone 1 mg/kg/day (25%), IV MP given 3 days weekly (17%), and IV MP given once weekly (17%). Most of the respondents who would use IV MP 3 days/month did not combine it with prednisone, while the majority of those who would use IV MP 3 days/week or 1/week would also treat with prednisone. About one-third of the respondents who would initially treat with prednisone 1 mg/kg/day would also treat with IV MP. The median duration of corticosteroid induction treatment was 2 months and median duration of total corticosteroid treatment was 4 months; 13% of respondents did not specify a duration for corticosteroid treatment (Tables 2 and 3). The total amount of corticosteroid given to this patient was calculated from each respondent’s specified dose and treatment duration. The median total corticosteroid treatment amount was 270 mg/kg for respondents treating with IV MP or combination corticosteroid, and 120 mg/kg for respondents treating only with prednisone. Respondents differed enormously in treatment specifics, with the total amount of corticosteroid given to this patient ranging from 30 to 1080 mg/kg and the total duration of corticosteroid treatment ranging from 0.25 to 30 months. Vignette variations and other clinical vignettes. Respondents were asked if they would alter treatment of this 178 The Journal of Rheumatology 2010; 37:1; doi:10.3899/jrheum.090708 Personal non-commercial use only. The Journal
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