Folic Acid


Folic Acid Supplementation Reduces Methotrexate Complications
10/30/2000 06:59:17 PM By Veronica Rose

Patients with rheumatoid arthritis should take folic acid supplementation   long term with the methotrexate therapy to avoid gastrointestinal side effects. 

Researchers in the United Kingdom designed a prospective, randomised,   double-blind, placebo-controlled trial to study the effect of stopping folic   aid supplementation in patients with rheumatoid arthritis who were already   established on methotrexate plus folic acid 5. They also aimed to report all   toxicity (including absolute alterations in haematological and liver enzyme   indices) and changes in methotrexate efficacy.

 Although folic acid is often given as an adjunct to methotrexate therapy,   researchers had no conclusive proof that it decreased the toxicity of   methotrexate, and there was a theoretical risk that it actually decreased   its efficacy. Participants included 75 patients, established on methotrexate <20 mg weekly   and folic acid (FA) 5 mg daily. 

Patients were asked to stop their FA and   were randomised to one of two groups, placebo or FA 5-mg daily and were   evaluated for side effects and efficacy prior to entry and then at   three-month intervals for one year. 

Twenty-five patients concluded the study early, eight (21 percent) in the   group which remained on folic acid and 17 (46 percent) in the placebo group,   with two patients in the placebo group discontinuing due to neutropenia. There was an increased incidence of nausea in the placebo group at nine   months. In the placebo group, there was significantly lower disease activity   on a few of the variables measured, although these were reported to be of   probably no clinical significance. 

Researchers concluded that FA supplementation was helpful in the prevention   of neutropenia with very little loss of methotrexate efficacy.

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