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[Methotrexate and folates in rheumatoid arthritis]
1Revmatologisk avdeling, Rikshospitalet, Oslo.
Summary
Low-dose methotrexate effectively treats rheumatoid arthritis, but side effects often lead to discontinuation. Folic acid supplementation, timed appropriately, can reduce methotrexate-related adverse events without compromising treatment efficacy.
Area of Science:
- Rheumatology
- Pharmacology
- Nutritional Science
Context:
- Methotrexate (MTX) is a cornerstone therapy for rheumatoid arthritis (RA).
- MTX efficacy and toxicity are dose-dependent.
- Adverse events, often linked to folate deficiency from MTX's antifolate properties, are a primary reason for treatment cessation.
Purpose:
- To explore strategies for mitigating methotrexate-induced side effects in rheumatoid arthritis patients.
- To evaluate the role of folate supplementation in improving MTX tolerability.
- To determine optimal folate supplementation protocols, considering timing and dosage relative to MTX.
Summary:
- Clinical trials investigated concomitant folic acid or folinic acid with MTX to reduce side effects.
- Key factors for successful folate supplementation include precise timing and the weekly folate-to-methotrexate ratio.
- Individually tailored folic acid supplementation is proposed, with dietary intake sufficient for some patients.
Impact:
- Optimized folate supplementation can enhance methotrexate adherence and long-term treatment success in RA.
- Reducing MTX side effects improves patient quality of life and reduces healthcare costs.
- Personalized approaches to folate supplementation may reduce the need for additional supplements in some RA patients.