Folic Acid Supplementation Reduces Methotrexate Complications
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. http://rheumatology.oupjournals.org/cgi/content/abstract/39/10/1102
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