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Folic Acid Supplementation Recommended In Methotrexate Treatment Of Rheumatoid Arthritis
A DGReview of :"Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review"
Rheumatology
01/21/2004
By Jill Taylor
Folic acid supplementation in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) improves tolerability, does not compromise efficacy, and may reduce the risk of cardiovascular disease, according to a British study.
MTX is the most commonly used disease-modifying anti-rheumatic drug (DMARD) in RA treatment. However, there is a 30% probability of MTX discontinuation 1 year after initiation of therapy, with side effects being the main influencing factor.
Some of these side effects, including gastrointestinal intolerance, cytopaenias and alopecia, are similar to those seen during folate deficiency. Moreover, folate deficiency is a recognised risk factor for MTX toxicity.
Researchers S. I. Whittle and Dr. Rod A. Hughes of the Department of Rheumatology, Ashford & St Peters NHS Trust, Chertsey, performed a review summarising current data regarding the use of supplemental folic acid in MTX therapy for RA to prevent adverse effects and potentially modulate cardiovascular risk.
Relevant literature was identified by Medline search and reviewed. Results showed that the use of supplemental folates, including folic and folinic acid, in RA patients treated with MTX improves continuation rates by reducing the incidence of liver function test abnormalities and gastrointestinal intolerance.
Furthermore, supplemental folic acid offsets the elevation in plasma homocysteine associated with the use of MTX, which may in turn reduce the risk of cardiovascular disease.
Folic acid supplementation has not been shown to compromise the MTX efficacy in the treatment of RA. Alternatively, evidence suggests that under some circumstances, folinic acid may reduce MTX efficacy.
The investigators conclude by proposing that folic acid supplements be prescribed routinely to all patients receiving MTX for the treatment of RA.
"We recommend a single dose of 5mg of folic acid once per week, taken on the morning following the day of MTX dosing," they said. "If adverse effects still occur, an increase to a single dose of 10 mg per week may be considered."
Rheumatology (Oxford) 2004 Jan 6;[Epub ahead of print].
"Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review"
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