Folate Supplementation can reduce the incidence of side-effects of Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review

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Folate Supplementation can reduce the incidence of side-effects of Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review

A systematic study was recently carried out to review the evidence for the benefits and harms of folic acid or folinic acid supplementation on methotrexate (MTX) treatment in patients with Rheumatoid Arthritis. The study also evaluated, whether folic acid supplementation reduces the MTX toxicity or reduce MTX benefits and decided whether a higher MTX dosage is essential. 

Dr Liu, Lijun et al. performed a sensitive search for abstracts from significant Rheumatology meetings, and major trial registers were also searched to retrieve all randomised controlled trials and database of Medline, Embase, Web of Science and Cochrane Library databases from inception to 2 June 2016 systematically.

On the whole 7 studies were included with 709 patients. It was found that RA patients treated with MTX, supplemented with folic acid were less likely to have elevated transaminase (odds ratio [OR] 0.15; 95% confidence interval [95% CI] 0.10, 0.23 [P < 0.00001]) and gastrointestinal side-effects such as nausea and vomiting (OR 0.71; 95% CI 0.51, 0.99 [P = 0.04]).

The folate supplementation reduced patient withdrawal compared to placebo (OR 0.29; 95% CI 0.21, 0.42 [P < 0.00001]). Where as, no statistical difference for mouth sores between folate and placebo (OR 0.83; 95% CI 0.57, 1.22 [P = 0.35]) were found.

Moreover, it was found that the disease activity markers in all those trials were not consistent. Thus it was not possible to decide whether folate supplementation reduced MTX efficacy.

The scientists also compared the high-dose of folate (≥25 mg per week) with low-dose folate (≤10 mg per week) on MTX efficacy, but no statistical difference (OR 2.07; 95% CI 0.81, 5.30 [P = 0.13]), nor on MTX toxicity (OR 1.56; 95% CI 0.80,3.04 [P = 0.19]) was observed.

The study concluded that the folic acid supplementation could reduce the incidence of hepatotoxicity and gastrointestinal side-effects of MTX in patients with RA. It also decreased patient withdrawal from MTX treatment. Also, there was no significant difference between high-dose folate and low-dose folate on MTX efficacy or toxicity.

Source

Journal of Clinical Rhematology

The source:

https://www.ncbi.nlm.nih.gov/pubmed/29975207

Original title of article:

Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review.

Authors:

  Liu, Lijun et. al.

SearchTags: 
Therapeutic, Rheumatoid Arthritis, Joints

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