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Adding Folates Alters Methotrexate Treatment In Rheumatoid Arthritics
A DGReview of :"Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis"
Annals of the Rheumatic Diseases (ARD Online)
04/21/2003
By Anne MacLennan
Efficacy of methotrexate (MTX), as well as final dose and toxicity are influenced by folate supplementation in treating rheumatoid arthritis, suggest researchers in The Netherlands.
They found the main baseline characteristics predictive of MTX treatment outcome in these patients are prior gastrointestinal (GI) events, body mass index, gender, use of non-steroidal anti-inflammatory drugs (NSAIDs) and creatinine clearance.
Dr M Hoekstra from the Department of Rheumatology, Medisch Spectrum Twente, Enschede, led this 3-centre study of factors linked with MTX toxicity, final dose and efficacy in RA. They used data from a 48-week randomised clinical trial in 411 RA patients treated with MTX, comparing folates and placebo, and, via logistic regression, examined the link between baseline variables and various dependent factors.
These factors included hepatotoxicity, MTX withdrawal, final MTX dose of 15 mg/week or more and MTX efficacy.
The researchers found the addition of folates to MTX treatment was strongly linked with lack of hepatotoxicity, whereas high body mass index was related to hepatotoxicity occurrence.
Prior gastrointestinal (GI) events and younger age were related to the adverse event, diarrhoea, the researchers report.
Hepatotoxicity and GI adverse events were the chief reason for MTX withdrawal, which, in turn, was linked with absence of folate supplementation, body mass index, prior GI events and female sex.
Renal function was not linked with toxicity.
Reaching a final dose of MTX of 15 mg/week or more was related to folate supplementation and the absence of prior GI events.
Efficacy of MTX treatment was associated with low disease activity at baseline, male sex, use of NSAIDs, and lower creatinine clearance.
Other contributors to this study were from The Netherlands Department of Rheumatology, University Medical Centre Nijmegen, Nijmegen, and the Department of Rheumatology, Leiden University Medical Centre, Leiden.
Ann Rheum Dis 2003 May;62(5):423-6.
"Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis"
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